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Dermatitis of the buttocks, genitals, lower abdomen, or thigh folds of an infant or toddler is called diaper rash. The outside layer of skin normally forms a protective barrier that prevents infection; when the barrier fails, the child may develop a rash in the area covered by the diaper. Diaper rashes occur equally with cloth diapers and disposable diapers.
Diaper dermatitis results from prolonged contact with irritants such as moisture, chemical substances, and friction. Urine ammonia, formed from the breakdown of urea by fecal bacteria, is irritating to sensitive infant skin. Ammonia by itself does not cause skin breakdown. Only skin damaged by infrequent diaper changes and constant urine and feces contact is prone to damage from ammonia in urine. Inadequate fluid intake, heat, and detergents in diapers aggravate the condition. Bouts of diarrhea can quickly cause rashes in most children. Diaper rash begins with erythema in the perianal region. Left untreated, the area can quickly excoriate and progress to macules and papules, which form erosions and crust. Under certain circumstances (in infants under the age of six months, toddlers who have been on antibiotics, and immune compromised children) diaper dermatitis may become secondarily infected with Candida ablicans. Sometimes severe diaper dermatitis becomes super-infected with bacteria (streptococci or staphylococci).
Diaper rashes occur in the diaper-wearing age group (birth to three years of age). Diaper rash occurs in about 10 percent of infants and is most common between the ages of seven and nine months. Some infants seem predisposed to diaper dermatitis. These infants have such sensitive skin that diaper dermatitis is a problem from the first few days of life.
When parents and caretakers do not change the children's diapers often, feces is in contact with skin and irritation develops in the perianal area. Urine left in diapers too long breaks down into ammonia, a chemical that is irritating to infant skin. Ammonia dermatitis of this type is a problem in the second half of the first year of life when the infant is producing a larger quantity of urine.
When the diaper area has prolonged skin contact with wetness the natural oils are stripped away, the outer layer of skin is damaged, and there is increased susceptibility to infection by bacteria or yeast.
Frequently a flat, red rash resulting from chafing of the diaper against tender skin causes friction rash. This rash is not in the skin folds. It may be more definite around the edges of the diaper, at the waist and leg bands. The baby does not seem to experience much discomfort.
Sometimes chemicals in detergents contribute to contact dermatitis. These rashes should clear up as soon as the chemicals are removed. Ignoring the condition may lead to a secondary infection that is more difficult to resolve.
Author Info: Aliene S. Linwood RN, DPA, FACHE, Thomson Gale, Gale, Detroit, Gale Encyclopedia of Children's Health, 2006This feature is for informational purposes only and should not be used to replace the care and information received from your healthcare provider. Please consult a healthcare professional with any health concerns you may have.
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