Your baby’s butt is officially the color of a ripe tomato. It’s mad flaming red diaper rash. At this point, you’re both covered head to toe in Desitin or Butt Paste, and you’re ready to pull your hair out, or maybe to cry along with your baby, because the rash is still there. Diaper rash (a.k.a. diaper dermatitis) is one of the most common skin conditions that can affect your baby or toddler, and it can be very painful. My youngest daughter was particularly prone to some pretty severe diaper rash, and if she happened to have a bout of diarrhea that day, look out! Not only is diaper rash painful, it can also be extremely hard to get rid of. That’s because when we treat for diaper rash, we generally don’t rectify all of the causes. One day during a particularly bad bout of diaper rash, I called up our pediatrician desperate for some advice, and they gave me their “secret cream” for diaper rash, one that’s an amalgam of several products that you would normally use all on their own. The magic of this recipe is that it treats for all the most common causes of diaper rash as well as the infections and additional symptoms that may come along too. I’ll provide the recipe for this “secret cream” below, but first…
What DOES cause diaper rash?
Rubbing. Most people’s first thought is that diaper rash is caused by the rubbing of the diaper, and if you thought that too, you were right – almost. Rubbing is certainly part of the problem, and may even initiate the whole condition. But while the skin on a baby’s bottom is indeed very sensitive, if you rubbed a clean, dry diaper on that skin, even for a long time, you might get a small rash or irritation, but you wouldn’t get the widespread inflamed rash that we generally see on our babies.
Urine and Fecal Matter. Add in a little urine and fecal matter to the cocktail, and now you’ll start to see some colorful changes. That’s because the urine and fecal matter change the PH of the skin. Normally, if you get urine or feces on the skin separately, they wouldn’t do much more than gross you out. But when urine and feces mix, a component in the feces breaks down the urine, releasing components that increase the PH of skin. Skin with a high PH is more susceptible to irritation. If your baby has diarrhea, there may be additional digestive enzymes in the stool that can also eat away at the skin. In fact, in studies, infants with diarrhea are much more likely to have diaper rash.
Diet. It might be surprising to think that something like the food your child eats could contribute to a rash in his or her diaper area, but many moms will tell you that particular foods make his/her child’s diaper rash worse. There is some research supporting this. Two studies, one in the US and one in Japan, investigated whether feeding infants formula versus breast milk influenced the potential of getting diaper rash. Infants fed formula had stool with higher PH and higher amounts of digestive enzymes called proteases compared to infants fed breast milk. Both the high PH and proteases can contribute to diaper rash. If you google diet and diaper rash, you’ll see many posts claiming that feeding your child acidic foods can contribute to diaper rash. While it is possible that consuming a lot of acidic foods could alter the composition of fecal matter, and ultimately contribute to diaper rash, I was not able to find scientific studies that directly tested this.
Soaps and Detergents. Commonly used soaps and detergents often have pHs that are much different than that of skin. A normal skin pH ranges from 5.4-5.9. A study was conducted to test the pH of many baby soaps on the market. Most of the bar soaps had very high pH. For example Dove baby had a pH of 8.61, and Johnson’s baby was 10.25! The liquid soaps were much lower. Johnson’s baby liquid soap, for example, was 5.61, right in the range of normal skin pH. Using soaps with high pH can increase the pH of the skin. Since a high skin PH can increase the risk of developing diaper rash, using soaps and detergents that are closer in pH to normal skin (like the liquid soaps) could help to prevent diaper rash, especially in infants that are particularly sensitive to it. Synthetic detergents (also called Syndets) are products made to have neutral or slightly acidic pH, and these can help to keep the pH of skin from going up, decreasing the risk of diaper rash. One example of syndet soap is Royal Derma Dermi Baby.
Yeast infection. Once you have some abrasions in the skin, many bugs can get in and cause even more problems. One of those is yeast. If your child’s diaper rash lasts more than 72 hours, he/she likely has a secondary yeast, or candidal, infection. This secondary infection makes the rash look even redder, more raw, and you’ll often see a raised border and some pustules or pimples as part of the rash. Sometimes you’ll also see some satellite spots outside of the main rash. Want to see an example of yeasty diaper rash? Check out this post specifically devoted to yeast diaper rash.
Bacteria. Whenever you have a break in the skin, like a rash, you can get a secondary infection with bacteria such as Staphylococcus aureus or Streptococcus organisms. This type is less common than a yeast infection, but present, it will also add to the inflammation and the painful nature of the rash. Signs of this include sores, yellow scabs, or pimples with draining pus. It is best to contact a doctor if you see this, because oral antibiotics may be needed.
Does the kind of diaper influence diaper rash?
The short answer is yes. One of the key ways to prevent diaper rash is to keep the baby’s diaper free of urine and fecal matter, and different types of diapers are more efficient at this. Cloth diapers contain very little absorbant material. When the diaper gets wet, the baby’s bottom stays wet until that diaper is changed. Before the 1980’s disposable diapers had the same problem…until the diaper companies invented something called Super Absorbant Polymer, or SAP. If you have ever accidentally broken a wet diaper open, you may have seen that some squishy gel crystals filled the diaper. These crystals start out as fine as sand, and they are very good at absorbing water. When the baby wets the diaper, the crystals pull the water away from the inner diaper surface and keep baby’s bottom dry.
It turns out that not only does SAP keep a baby’s bottom dry, it reduces the risk of diaper rash as well. In a series of four studies including 1600 babies, researchers from Procter and Gamble showed that infants wearing diapers with a type of SAP called Absorbant Gelling Material (AGM) had lower skin PH and better rash scores compared to infants wearing cloth diapers and disposable diapers without AGM. In fact, the infants wearing the cloth diapers fared the worst overall. Since the 1980s, nearly all diaper brands contain Super Absorbant Polymers. Pampers is the brand that contains a description of AGM in particular in its FAQ.
In addition to the type of absorbant material diapers contain, the dyes in the diapers could also contribute to diaper rash. A study in 2005 detailed the incidence of diaper rash that was linked to dyes in the portions of the diaper that contacted the infants’ skin. Using dye-free diapers eliminated the problem. This means that the rash likely resulted from an allergy to the dye. Using dye free diapers would eliminate that risk.
So what is the best way to treat diaper rash?
When you head to the store to find a treatment for your baby’s diaper rash, you’ll quickly find an arsenal of pastes, lotions, and ointments to choose from. These treatments usually have one of the following active ingredients:
- Zinc oxide – this is an oxidized form of a metal (zinc) that acts to repel water, and creates a barrier that allows skin to heal. Brands for which this is the active ingredient include Desitin, Butt Paste, and Triple Paste, among others. Desitin and Butt Paste come in regular and maximum strength forms. Regular versions have 13-14% zinc oxide while maximum strength has a whopping 40%. I was not able to find any studies testing whether the percentage in maximum strength works better than the percentage in regular versions of these products.
- Petrolatum – also called petroleum jelly, helps to protect and moisturize skin.
- Lanolin – also called wool wax, it’s a secretion (sebum) from the skin glands of sheep. When applied to skin, it moisturizes and protects skin.
Which of these should you choose? Should you choose any of them? More than one of them? The first step is really to try to find the initial cause of the diaper rash. Does the baby have diarrhea? Are diapers being changed immediately after wetting and/or soiling? Are there dyes on the diapers that are touching the skin? Are you using abrasive soaps during bathtime? Eliminating these potential risk factors can prevent the diaper rash from recurring. For now, though, I’m sure you want to get rid of that rash right away! If the rash has only been there for a day or two and looks mild, a paste containing zinc oxide will likely work quite well. We used Maximum Strength Desitin in our house, and even still do when we encounter a chafing problem.
What about when diaper rash is really bad and/or lasts for a long time?
Products with zinc oxide don’t act to directly heal the skin. They only prevent additional irritants from hitting the skin, allowing the skin to heal on its own. When the inflammation and irritation have really gotten out of hand, you’ll likely need something that can not only protect the skin, but can also help to heal it as well. Petrulatum will help to moisturize the skin in case it is dry, but if there is a secondary infection, you’ll need the anti-fungal, and perhaps even an antibacterial component. If you see signs of a secondary yeast or bacterial infection, I suggest contacting your doctor. In the meantime, our pediatrician recommended a concoction (the “secret cream” mentioned above) that attacks the diaper rash from multiple angles, and it works wonders!
So what is in this “secret cream”?
Here’s what you’ll need:
- A 4 oz tube of Desitin cream
- A 2oz tube of Lotrimin
- A tube of Neosporin
- A 2oz tube of A&D ointment
- Half a cup of liquid antacid (such as Malox)
All you have to do is mix these together and apply! The lotrimin and Neosporin will help to combat any secondary yeast and bacterial infections that may be present. The lanolin and petrolatum in the A&D ointment will help to moisturize and protect the skin. The antacid will help to neutralize any digestive enzymes present, and the zinc oxide in the Desitin will help protect the skin from additional moisture.
Unfortunately, this concoction does not come cheap (approximately $60 for all ingredients), but it makes a lot and you can store it in an air-tight Tupperware container for a long time. We had ours for over a year. I recommend scooping some out into a secondary container so you don’t have to worry about contaminating it with your fingers as you apply. For me, the almost instant relief it gave my screaming baby was beyond worth the cost when all was said and done. While this concoction was recommended to me by our pediatrician’s office, I still suggest you contact your child’s doctor to make sure it will work for your baby. Wishing you all rashless baby butts!
Want to know more about what makes great diapers? Check out the post below:
ab.com/expert-advice/what-is-inside-those-disposable-diapers
Contributing References:
Longhi, F., Carlucci, G., Bellucci, R., Di Girolamo, R., Palumbo, G., & Amerio, P. (1992). Diaper dermatitis: a study of contributing factors. Contact dermatitis, 26(4), 248-252.
Visscher, M. O. (2009). Recent advances in diaper dermatitis: etiology and treatment.
Campbell, R. L. (1987). Clinical tests with improved disposable diapers. Pediatrician, 14, 34-38.
Tarun, J., Susan, J., Jacob Suria, V. J. S., & Criton, S. (2014). Evaluation of pH of bathing soaps and shampoos for skin and hair care. Indian journal of dermatology, 59(5), 442.
Mendes, B. R., Shimabukuro, D. M., Uber, M., & Abagge, K. T. (2016). Critical assessment of the pH of children’s soap. Jornal de Pediatria (Versão em Português), 92(3), 290-295.
Alberta, L., Sweeney, S. M., & Wiss, K. (2005). Diaper dye dermatitis. Pediatrics, 116(3), e450-e452.
Visscher, M. O., & Hoath, S. B. (2006). Diaper dermatitis. In Irritant dermatitis (pp. 37-51). Springer, Berlin, Heidelberg.
Klunk, C., Domingues, E., & Wiss, K. (2014). An update on diaper dermatitis. Clinics in dermatology, 32(4), 477-487.
Fiorillo, L. (2004). Therapy of pediatric genital diseases. Dermatologic therapy, 17(1), 117-128.
