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Expert Q&A
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| By John Dorsey, M.D. Pediatrician | ||
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My daughter has a terrible diaper rash. I have tried Desitin, yeast infection prescription, A&D ointment and Vaseline. Nothing seems to help. Her little area looks like raw meat. It has open sores and she sometimes scratches. It may go away for a day, but then it comes right back. She is 11 months and is cutting teeth. Any information would be appreciated.
Diaper rashes fall into two basic categories: irritant and infectious. Irritant dermatitis results from chemicals (including urine and feces) contacting the skin. The warm, moist, dark area covered by the diaper becomes irritated, and is a wonderful breeding ground for bacteria and fungi. Once these organisms take hold, infectious dermatitis becomes the major factor. As you can see, frequently both irritant and infectious diaper rashes co-exist.
There are many treatments, some more practical than others. Leaving the diaper off is one of the best (and sometimes one of the messiest) solutions. Using cloth (cotton) diapers instead of disposables helps as well, as long as one doesn't also apply rubber or plastic overpants.
Keeping the skin clean is very important. Sometimes baby wipes can cause irritation, and should be avoided in severe cases. Just using a soft cloth with warm water will do quite nicely.
Cool baths or compresses will sometimes help ease discomfort, and analgesics may also give some relief.
Ointments are usually better than creams because they form a protective layer over the skin. Zinc oxide and petrolatum preparations are very good. Occasionally antifungals are needed, and, rarely, topical antibacterials may be in order. In very rare cases, oral antibiotics are called for.
In very severe cases, steroids are warranted. These should be used sparingly, only under a physician's supervision, and not for prolonged periods of time, because of a significant risk of side effects or worsening infection.
If a diaper rash is severe or persistent, a visit to the doctor is wise. While it is rarely serious, it is uncomfortable.
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