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Diaper Rash

Expert Q&A

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Updated May 10, 2007

Q. My 21 month old toddler has bad eczema on his bum. I have tried everything, and it says I should not use steroid cream under his nappy. It is driving him nuts! What can i use? Leighsa, UK

A. You are correct that it is usually recommended that you avoid using steroid creams or ointments under a child's diaper. Steroids are absorbed much more readily under occlusion, like from a diaper, and can increase a child's chances of having side effects.

However, although steroids are commonly prescribed to treat eczema, eczema is not very common in the diaper area, so it is likely something else causing his rash. Eczema more typically causes a red, itchy rash on a child's cheeks, arms, and legs. Still, if you really think that it is eczema, you can ask your doctor if you can use a mild potency steroid, like those sold over-the-counter, for a few days.

So if it isn't eczema, what might be causing your child's bad diaper rash?

It could be caused by drinking too much juice or eating a certain fruit or some other food. Citrus fruits and citrus juices are notorious for causing bad diaper rashes in sensitive kids.

Irritant Diaper Rash

Although frustrating for parents, most children get at least one diaper rash, and many get them over and over. If your child gets frequent diaper rashes you might change the type of diaper you are using (cloth vs. disposable diapers), change brands of disposable diapers and/or baby wipes, apply a barrier cream after each diaper change, like Aquaphor or a cream with zinc oxide, and keep a symptom diary to see if you can link the rash to something that your child is eating or drinking.

Other things that parents do to prevent diaper rashes include:

  • frequent diaper changes
  • letting their infant go without a diaper as much as possible
  • using unscented wipes
  • using warm water and a mild soap instead of wipes
  • using a squirt bottle to clean without rubbing
  • letting the diaper area fully dry before putting another diaper on
  • get your child potty trained, which is the only real 100% way to prevent diaper rashes
To treat a diaper rash, you can do many of the same things, but try to avoid vigorous rubbing of sore areas. A squirt bottle and then gently patting your infant dry can be less irritating. Next, after allowing him to completely dry, let him air out a little longer if possible, and put a generous amount of your favorite diaper rash cream or ointment to completely cover the rash. You can repeat this at each diaper change and see your Pediatrician if the diaper rash isn't getting better after a few days.

If your child has raw and irritated areas of skin with his diaper rash, you might ask your Pediatrician if you can use a mild, over-the-counter strength brand of hydrocortizone. Some parents like to use Maalox topically in this situation.

Yeast Diaper Rash

The most common thing to cause a persistent diaper rash, which isn't getting better with routine diaper rash treatments, is a yeast infection. This type of diaper rash is caused by Candida albicans, which also causes thrush. Yeast diaper rashes appear as a bright red rash with small red bumps around it and it requires treatment with a topical antifungal cream.

Less Common Causes of Diaper Rashes

When a diaper rash persists and is not easily treated, it may be time to see a Pediatric Dermatologist for further evaluation. Some of the less common conditions that can cause a diaper rash in children include:
  • Seborrheic Dermatitis - with greasy, yellow or salmon-colored scales that also occur on a baby's face, behind their ears, and on their scalp and armpits
  • Psoriasis - which may also involve a child's scalp and nails
  • Zinc Deficiency - includes a poor diet, diarrhea, hair loss, and a rash around a child's mouth
  • Acrodermatitis Enteropathica - a genetic cause of zinc deficiency
  • Histiocytosis X
  • Wiskott-Aldrich Syndrome - with bleeding, serious infections, and eczema
  • Congenital Syphilis
Keep in mind that these conditions usually have other symptoms besides a simple diaper rash and most are not very common.

Diaper Rash Treatments

In addition to using an antifungal cream to treat yeast diaper rashes, the following diaper rash creams and ointments can be helpful:
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