Diaper Rash in Children

Diaper rashes are rashes on the skin of the groin and buttocks. Despite the name, these rashes can appear even when your child is out of diapers. The phrase has come to describe any rash that appears in the area covered by diapers, pull-ups, and even underpants. This includes the buttocks, the skin folds of the thighs, the penis or vagina, and around the anus.

There are four basic types of diaper rash: irritation rashes, chafing rashes, yeast infections, and bacterial infections. Many other types of rashes that appear in the diaper area also appear on other parts of the body. These rashes — including eczema, psoriasis, impetigo, and scabies — are not exclusive to the groin and buttocks area.

An irritation rash is the most common diaper rash. Disposable diapers with strong absorbent chemicals or flowery perfumes sometimes cause these rashes. Cloth diapers that are washed in perfumed detergents or dried with a fabric softener also can be problematic. Other sources of irritation rashes are urine and stool that sit next to the skin. This problem is most common among diaper wearers but also occurs among underpants wearers who have accidents or don’t wipe thoroughly. In fact, the simple act of covering the diaper area for long periods of time with tight-fitting diapers, pull-ups, or damp underpants can be enough to cause a rash.

Whatever the irritant, the rash looks basically the same: splotchy and pinkish red. Some children are not at all bothered by it; others protest with diaper changes or simple cleaning of the area.

A chafing rash results when the diaper rubs against the skin, causing redness where the rubbing takes place. Chafing is made worse when younger toddlers have healthy fat folds in the groin and thighs. These folds rub against each other and trap moisture, adding another source of irritation. Chafing can also occur when a child’s thighs rub together as he walks or runs, especially if he is knock-kneed or flat-footed. Chafing rashes usually look redder than irritation rashes. Extreme rubbing can cause bleeding or blistering. The worst part of the rash is usually tucked between folds of skin where air does not circulate.

A yeast infection (typically caused by the fungus Candida) is another source of rash in the groin area. Yeast is a normal inhabitant of the human body, but it is present in limited amounts. In areas that are warm, moist, and dark, yeast can grow quickly, sometimes out of control. The groin and buttocks are covered most of the day and night, providing the perfect breeding ground for yeast. This is especially problematic with toddlers who wear diapers or pull-ups, but even potty-trained children can get yeast rashes. If underpants are slightly damp from poor wiping or a little leakage, the environment mimics a humid diaper.

Most people expect yeast to look white, as it does in the mouth (in the form of thrush), but in the diaper area, it does not. A yeast diaper rash has irregularly shaped red patches with a shiny or leathery sheen. When a child has a yeast infection, wiping the diaper area usually stings. And to make matters worse, given the causes of yeast infections, these rashes can be harder to get rid of than many other diaper rashes unless you are willing to let your child run around without a diaper or underpants for much of the day.

Sometimes yeast rashes occur on their own, but often they exist in conjunction with another diaper rash. This double whammy occurs because irritated skin — regardless of the cause — breeds yeast easily. Therefore, the signs of yeast may appear all over the groin area or in isolated small patches, alone or on top of a preexisting rash.

A bacterial infection in the diaper area occurs when bacteria that normally live on top of our skin in small numbers get beneath the skin and multiply. This can happen when the skin is dry or chapped and has small breaks in it. The result is a fiery red rash, sometimes oozing yellow liquid or white pus. Occasionally, the rash will scab over. Most bacterial rashes are warm to the touch and cause intense pain with wiping. They can appear as distinct spots all over the area or as a continuous swath of infected skin.

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