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Ask the Experts: Deciphering diaper rash Ask the Experts

Ask the Experts: Deciphering diaper rash

How can I tell the difference between a yeast diaper rash and a regular diaper rash?

A: Diaper rash affects most babies at one time or another. The most common cause is known as contact dermatitis. This rash develops when skin that is in direct contact with a soiled diaper becomes red, raw and irritated. It’s important to note this type of diaper rash does not appear in the creases and folds of baby’s skin.

Most health care providers recommend applying 1 percent hydrocortisone followed by a topical antibiotic (Neosporin, Bacitracin, etc.) to the raw areas and then covering them with a thick layer (like frosting on a cake) of a “barrier” cream or ointment (Desitin, Vaseline, A&D ointment, etc.). There are also many natural creams without phthalates, parabens, petrolatum or sodium laurel sulphate. These generally work just as well.

Cut down on the use of diaper wipes for a few days, and instead clean bitty bottoms with warm water (and a mild soap if necessary). Improvement should be visible within 24 to 48 hours.

Contact dermatitis typically resolves within 7 to 10 days. The best ways to prevent it are to change diapers frequently and apply a barrier ointment or cream to the skin before a rash develops.

If the rash doesn’t go away or worsens, it may be that your baby has developed a yeast infection. Do not panic! Yeast infections are easily treated once identified.

Yeast (which is a fungus) and bacteria normally colonize our skin. This does not cause a problem as long as they are in balance. Because yeast grows in dark, moist and warm environments, a wet, soiled diaper can be the perfect breeding ground. A rash resulting from the overgrowth of yeast is usually red, slightly raised and has small red dots extending beyond the main part of the rash. It often starts in the deep creases of skin but can spread to skin on the front and back. Sometimes an odor may be detected.

Notify your pediatrician if you suspect a yeast infection or if baby’s diaper rash doesn’t resolve within a week. Treatment for a yeast infection usually involves applying a layer of antifungal cream (Lotrimin, etc.) covered with a thick (frosting-like) layer of a barrier ointment or cream. It also helps to expose the baby’s bottom to air intermittently during the day.

The best ways to prevent any type of diaper rash are to change soiled diapers promptly, clean baby’s skin thoroughly and make sure the diaper area is completely dry before putting on a new diaper.

—Carole Kramer Arsenault, RN, IBCLC, founder of Boston Baby Nurse and Nanny and author of Newborn 101: Secrets from Expert Nurses on Preparing and Caring for Your Baby at Home