Diaper Rash: Everything You Need to Know.

Also known as diaper rash, buttock erythema is a skin inflammation localized to the buttocks, thighs, and groin area.

This inconvenience primarily affects children, although it can also affect adults. Diaper rash can result from multiple factors, often associated with each other. One of the main causes is a humid environment, especially when the skin is in prolonged contact with feces or urine. This phenomenon is even more problematic in the case of diarrhea, when the stools are particularly irritating. Humidity promotes skin maceration, making the epidermis more vulnerable to lesions. Urine, by altering the pH of the skin and producing ammonia, is particularly involved. Indeed, ammonia promotes the activity of fecal enzymes, such as proteases and lipases, which degrade the skin barrier and increase skin permeability, making it more fragile and prone to inflammation.

Friction, often related to ill-fitting or overly tight diapers, also represents a major cause of diaper rash occurrence. Constant rubbing against the skin can compromise the integrity of the skin barrier, making the skin more susceptible to irritations. This is particularly true when a baby is heavily swaddled, thus creating an environment conducive to sweating and moisture. In parallel, some disposable diapers, containing irritants for the sensitive skin of infants, can exacerbate the symptoms of diaper rash. Although all babies can be affected by diaper rash, girls seem to be more affected, probably due to greater exposure to diaper friction. This is at least what a study conducted by HOATH and his team on 31 infants suggests.

Primarily, diaper rash is an inflammation, the first symptom to identify it is a redness of the skin on the buttocks. This irritation can extend to the groin folds, thighs, and genital areas, zones particularly sensitive to friction and moisture. The affected area becomes more reactive and sensitive to touch and may appear slightly swollen, a sign of an ongoing inflammatory reaction.

Beyond redness, diaper rash causes irritation and itching, leading to a sense of discomfort for the baby. The baby may become more restless, cry more, especially during diaper changes or baths, where contact with water and wipes can exacerbate the discomfort. In some cases, more pronounced red patches may form, sometimes accompanied by small vesicles. These signs indicate a more advanced skin condition and require special attention to prevent a skin infection, particularly by yeasts of the type Candida albicans.

Even though diaper rash is generally mild in most cases, it requires attention. Primarily, it's crucial to keep the areas of the buttocks, groin, and thighs clean. To do this, regularly change diapers, as well as clothes that have been soiled by urine or feces. Regularly clean the area with warm water, a gentle soap, and clean cotton or a microfiber towel. Avoid scented wet wipes, which could promote skin irritation. As much as possible, it is also recommended to leave the infant's skin exposed to the air, to minimize friction as much as possible. Some natural treatments, like chamomile or calendula extracts or sunflower oil, known for their anti-inflammatory and hydrating properties, can also alleviate diaper rash.

Finally, if that's not enough, ointments such as the Oxyplastine or the Eryplast, or corticosteroids can be used. However, caution is advised with the latter: they should be used twice a day and their use should not be extended beyond two weeks. Indeed, corticosteroids are very effective in case of skin inflammation but, if used excessively, they can alter the skin barrier and cause epidermal atrophy, particularly on the sensitive skin of newborns.

• HOATH S. & al. Development of Diaper Rash in the Newborn. Pediatric Dermatology (2001).

• SCHEINFELD N. Diaper dermatitis: a review and brief survey of eruptions of the diaper area. American journal of clinical dermatology (2005).

• TIERNEY N. & al. Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management. Pediatric Dermatology (2013).

• NIU G. & al. Safety evaluation for ingredients used in baby care products: Consideration of diaper rash. Regulatory Toxicology and Pharmacology (2017).

• HASANPOOR-AZGHADI S. B. & al. A Review Study of Diaper Rash Dermatitis Treatments. Journal of Client-Centered Nursing Care (2018).