Diaper Rash

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What causes diaper rash?

There are several categories of causes for this dermatitis. First and foremost is "irritant" or "contact" dermatitis. Skin involvement may vary from mild redness (similar in character to a sunburn) to erosion of the top layers of skin. A characteristic differential point of contract diaper dermatitis from other causes of diaper rash is that it rarely involves the skin fold regions -- therefore, it spares areas not in contact with urine/stool.

Skin infections compose the next most common category of diaper rash. Bacteria (staph and strep) and yeast/fungal (Candida) are common causes of diaper rash. Generally both of these types of infections tend to result from a disruption of skin integrity and overwhelming the natural defense mechanisms of skin in this diaper region. Staph and strep bacterial infections are commonly termed impetigo. Classic descriptions of impetigo include small (1-2 mm) tiny blisters (vesicles) and pustules that tend to easily rupture leaving multiple erosions in a sea of generalized skin irritation. Candida diaper dermatitis also has several distinguishing patterns. The rash is characterized by zones of bright red skin with a series of discrete 2-4 mm "satellite" lesions at the borders of the confluent irritated skin. In contrast to contact dermatitis, Candida is generally only found in the skin folds creases and often around the anal region. Infectious causes of diaper dermatitis can generally be diagnosed by visual inspection alone. If confusion exists, laboratory studies of swabs of the involved areas may be obtained.

Allergic reactions are a less common cause of diaper rash. Commonly proposed allergens are fragrances and components of the diaper and wipes. These regions often have well-defined zones of redness with superficial vesicles and erosions. If the diagnosis of allergic skin reaction is suspect, skin-patch testing may be done to identify the offending agent. This is rarely necessary.

In addition to the common place causes of diaper rash, there are also a few very unusual causes of this problem. Unusual infections, metabolic and nutritional deficiency states, and immunodeficiency states and malignancies can all be implicated. Unfortunately, child abuse (hot-water immersion, extreme neglect to infant hygiene) can also appear as diaper rash.

Medically Reviewed by a Doctor on 5/13/2015

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