• DrSwae

The Hills and Valleys of Diaper Rash



A long time ago I agonized over diaper rash. I didn't know what to do. Anything I did seemed to aggravate it. Things got worse instead of better. I wondered if it would scar. I didn't know how to tell what was causing it so I worried we would never turn the corner. Most of all, it was terrible to watch my babe deal with the pain of a sore bum. I was a new mom and a new doc, and I didn't know what was awaiting down the aisle.


That was then, this is now.




Twelve years have passed (boy they went by like the rocket SpaceX launched into brilliant orbit!) And I have learned quite a lot. I started residency, finished it, taught medical students whose worries were once my own, taught wonderful residents, joined a private practice, welcomed three more babies, said Godspeed to loved ones whose earthly skin I had touched for the last time, and survived a pandemic. Whew. Life has its hills and valleys.


Along the way, I learned a great deal about diaper rash. I'm going to share it with you. This post is for all the mom's out there who may be agonizing over diaper rash right now too. I hear you. I feel you. You and your babe will get through this, and I am here to help make that happen a little easier and faster. This one's for you, mamas, once and always.


Just like life, diaper rash too has its hills and valleys. Pay attention to them to help see the way forward.


The content of all diapers can be pretty ripe. This is a rule whether you choose to cloth diaper, synthetic diaper, chlorine-free diaper, use a service or invest in plastic pants or whatever your fancy. I tell my patients that the more often they can get the diaper changed, the faster things will start to turn around. (This brings me to a post on diaper type which I'll publish later, more to come...)





The contents in the diaper, sit on the skin and alter the pH of baby's bum, which has a protective "acid mantle". When the waste sits on the skin for too long, its slightly alkaline nature can slowly irritate and erode this acid mantle. This happens in the areas that touch the contents, most commonly the mounds of the bum. Let's call them the hills. When irritation is from diaper contents sitting on one skin too long, I tend to see redness most prominent on those teeny little hills. This is the most common cause of diaper rash.



When redness on the HILL (HILL=IRRITANT DERMATITIS) happens, I treat it by:

  1. frequent diaper changes

  2. barrier cream


But this is different from diaper dermatitis from a yeast infection. Yeast, Candida sp usually, is normal in our gut flora. Sometimes it overgrows, and that is not normal. Yeast loves warm moist environments, which makes the inside of a diaper just a perfect place for it to thrive. More importantly, it makes the little crevices of a bum an even better place for it to overgrow. Candida or yeast diaper dermatitis happens in the valleys.

Another good clue I search for when I suspect yeast dermatitis is something called the "satellite papule/pustule". These are tiny bright red bumps, sometimes filled with pus (think whitehead) that tend to form a bit away from the rash. They look like this:



photo cred: Semantic Scholar: American family physician 2005



When I see satellite papules plus redness in the VALLEY (VALLEY=YEAST/CANDIDA DERMATITIS), I treat it by:

  1. frequent diaper changes

  2. barrier cream

  3. adding an anti fungal.

Though there are plenty of over the counter anti fungal agents I sometimes troubleshoot with over the counter baby products like wipes that contact grapeseed extract which is a natural antiyeast. Plenty of those available on the web like this.


There are times when I think it is important to have people call a doctor sooner, like if they see the skin looking dark or dusky or if there is a lot of bright redness around the opening of the bottom or if the baby has a fever. the skin is broken down or baby can't seem to get comfortable. Those things can be dangerous when they happen, so if I'm triaging on the phone with a mama, I try to sort these out. Babies with these symptoms need medical attention right away. But the huge majority of cases of diaper rash can be successfully treated with time and the right intervention. I always remind myself of the hills and valleys when I'm trying to navigate through a diaper journey. And these days I go a little more easy on myself, and I hope you do too. Twelve years later all the memories will be beautiful and you'll be so proud of your beginnings.




Of course there is no substitute for one on one medical advice from your doctor. If you have concerns, call your physician.