Globusz^® Publishing 

DIAPER RASH

iaper rash, the bane of young mothers, the frustration of young fathers, and often the challenge of seasoned pediatricians, is a very common skin ailment. Beginning for the most part between the ages of two and four months, this itchy, burning, painful, nasty-looking rash can result in restlessness, irritability, and sleep interruption, and can persist for months or until your child outgrows diapers.

Also known as napkin or diaper dermatitis, diaper rash is any eruption on an infant’s buttocks, genital and anal areas, lower abdomen, and upper thighs that manifests itself during the diaper-wearing stage. Although the problem is usually a minor one, it can, when ignored, lead to widespread infection by bacteria or fungi necessitating vigorous and prolonged treatment.

In its early and simple form, diaper rash is characterized by redness or chafing of the skin that is covered by the diaper. When left untreated, small pimples – called papules – and water blisters – called vesicles – develop. This can progress to oozing, sogginess in the skin folds and, in severe cases, open sores. The sharp, pungent odor of ammonia usually accompanies this rash.

It is a truism to say that the villain in all cases of diaper rash is, sad to say, the diaper. Babies do not, and cannot, develop diaper rash if they do not wear diapers! In our society, however, it is de rigueur for our infants to sport diapers: cloth, synthetic, treated, odor preventing, and a host of other types and styles. Most Greek babies – primarily those who are brought up on the smaller islands – do not develop diaper rash because they are regularly cleansed by their mothers who cradle them in their left arm while the right arm washes away the urine and soiling under a stream of warm tap water.

Other causes of diaper rash include rubber or plastic pants that constrict and prevent the skin that is covered by the diaper from “breathing.” This can be further aggravated by the rough edges of these pants as well as by tightly pinned diapers.

Frequent loose stools with their noxious intestinal enzymes can irritate the delicate diaper area, especially when these stools have not been completely removed by cleaning. Other causes of irritation include harsh soaps for cleaning the skin; strong detergents, antiseptic rinses, perfumed fabric softeners, and assorted baby oils, salves, ointments, and other chemical irritants.

High heat and humidity also contribute to diaper rash as they cause the skin and skin folds to become waterlogged. This creates an inflammation around the sweat pores and prevents the normal flow of perspiration, thus lowering the resistance of the skin to infection. The normal, usually “friendly” and harmless germs, such as bacteria and fungi, then begin to thrive and set up housekeeping in these trapped fluids and become “unfriendly” and harmful.

Although the situation often seems dismal, there are some positive steps you can take to prevent and treat diaper rash. Here are a few suggestions for prevention:

• Use soft, cotton diapers.

• Change diapers as soon as they are soiled and at regular intervals. Newborns urinate more than 20 times a day and one-year-olds average six or seven times a day. Therefore, be on the alert and learn to anticipate.

• Use plastic and rubber pants only sparingly and for short periods of time, such as for party occasions. Never use them at night.

• Following each diaper change, clean the diaper area thoroughly but gently with a mild cleanser, such as Cetaphil Cleanser, to remove all bacterial and fecal contamination. Pay careful attention to the skin folds. These folds should be washed gently and then rinsed thoroughly to make certain that all the cleanser is completely removed.

• Dry the skin and the skin folds thoroughly.

• Use a medicated cornstarch-based powder two or three times daily to keep the affected areas dry.

• Wash diapers in mild soap or detergent. Make sure they are carefully and painstakingly rinsed.

• Don’t use the perfumed fabric softener pads that are placed in clothes dryers. Even the non-perfumed varieties have a softening agent that may also be responsible for aggravating diaper rash.

• Dress your child in clothing that is porous enough to allow good air circulation.

• Keep air in the child’s room cool and dry.

• Encourage early training in regular toilet habits.

If your child is already suffering from diaper rash, the following steps can help clear it up and forestall further irritation, inflammation, and infection:

• Stop all previous medication.

• Discontinue plastic and rubber pants.

• Never use soap when the skin is inflamed.

• Apply wet dressings, compresses, or 15-minute baths using Burow’s Solution (two Bluboro or Dome-Boro or Pedi-Boro packets dissolved in one quart of warm water) every three or four hours to soothe and cool the inflamed areas.

• Allow the affected areas to “breathe.” Air is a marvelous healing agent. I strongly recommend that you permit infants and children with diaper rash to lie about and run around naked for several hours a day! Remember: your child cannot develop a diaper rash if he or she doesn’t wear diapers.

During the acute stage of diaper rash, I urge that you discontinue all diapers during the day. Use a double layer of soft, cotton diapers, very loosely pinned, at night. Never use plastic or rubber pants at any time.

When the inflammation, oozing, and sogginess have begun to clear and dry up, use a soothing and protective preparation, such as Zinc Oxide Ointment, at night. Finally, when the affected areas have adequately healed and the child is more comfortable, you may use soft cotton diapers again.

Be especially careful and conscientious, change the sheets as often as necessary, wash the soiled areas gently but thoroughly, and reapply the Zinc Oxide Ointment after each soiling.

PRICKLY HEAT

rickly heat is a common disorder of the sweat apparatus. It arises when the free flow of sweat to the surface of the skin is obstructed. The medical term for this condition is miliaria.

Sweat is produced by the more than 2 million sweat glands in the skin. Under normal conditions, it flows out smoothly and uninterruptedly to the skin surface by tiny sweat ducts. If the sweat is heavy and prolonged, it can clog the ducts and become trapped. This trapped sweat, unable to reach the skin surface, breaks through the walls of the ducts. The result is an inflammation of the skin known as prickly heat, or heat rash.

While prickly heat can materialize at any age, there is a tendency for it to occur more commonly in infants for two reasons: the relatively small size of the sweat ducts encourages closing of the pores thereby favoring sweat retention, and parent’s instinctive overprotection of the infant from the cold contributes to the warmth and humidity in which heat rash flourishes.

Prickly heat often appears suddenly and takes the form of numerous, tiny, reddish pimples and water blisters scattered in the creases of the neck, under the chin, in the armpits, and on the chest, back, abdomen, and buttocks. Recurrent crops may continue indefinitely and can cause restlessness and irritability, as well as burning and prickling sensations.

Prickly heat can result from any condition that encourages profuse and prolonged sweating along with inadequate evaporation of the sweat. The offender can be an excessively hot and humid climate or a fever. Indeed, persistent and extensive cases of heat rash are most common in tropical climes. Aggravated by obesity and tightly fitting garments, prickly heat usually clears up on its own, and only rarely do complications, such as secondary bacterial and fungal infections, materialize. While it lasts, however, it can be very distressing, particularly for young children.

There are, fortunately, some simple and effective methods to prevent and treat prickly heat. The primary concern is to keep the skin cool and dry. This is easy: keep the air cool and dry. Other helpful suggestions include the following:

• Use an air-conditioner or fan to reduce the temperature and humidity.

• Maintain adequate room ventilation to help the evaporation of sweat.

• Dress your child in loose-fitting, lightweight cotton clothing and limit physical activity in hot, humid weather.

  If prickly heat has already taken place, try the following treatment:

• Apply soothing and drying lotions, such as plain calamine lotion.

• Use a cornstarch-based dusting powder.

• If possible, allow the afflicted child to lie about the house naked.

• Wash with a cleanser, such as Cetaphil Cleanser, and never use greases or ointments that will further clog the sweat ducts.

• During the acute phase of prickly heat, give the child lukewarm baths, preferably with Linit Starch or Aveeno Bath Regular Formula.

Of course, the main answer to prickly heat is to stay cool!

For further information about diaper rash, log on to www.aad.org 1-888-462-DERM x22 or www.familydoctor.org/healthfacts/051

RECAP

• Diaper rash is any eruption on an infant’s buttocks, genital and anal areas, lower abdomen, and upper thighs that manifests itself during the diaper-wearing stage.

• During the acute stage of diaper rash, discontinue all diapers during the day. Use a double layer of soft, cotton diapers, very loosely pinned, at night. Never use plastic or rubber pants at any time.

• Prickly heat can result from any condition that encourages profuse and prolonged sweating along with inadequate evaporation of the sweat. The offender can be an excessively hot and humid climate or a fever.

TREATING DIAPER RASH

For the weeping and oozing of acute diaper rash, apply soothing wet dressings of the following to help relieve the inflammation and make the child more comfortable:
DomeBoro Powder Packets
Bluboro Powder Packets
Directions: Dissolve the contents of one packet in a pint (16 ounces) of warm water and apply as open wet dressings for 15 to 20 minutes every 2 or 3 hours. (See page 000 for directions for applying wet dressings.)

After the acute inflammation has subsided with the wet dressings, apply the following:
Triple Paste or
Zinc Oxide Ointment
Directions: Apply at night to the affected areas.

TREATING PRICKLY HEAT

Baths:
Aveeno Bath Regular Formula or
Linit Starch
Directions: See directions on the labels.

Cleansing Agents:
Cetaphil or
Aveeno Bar

Powder:
Any Baby Powder

Lotion:
Plain Calamine Lotion
Directions: Apply 2 or 3 times daily and after the bath.