Adults often look with envy at the delicate, velvety skin of children, so thin and soft that they just want to touch it with their cheeks. However, this refinement and tenderness needs increased protection. Otherwise, the baby's bottom instantly "blooms" and begins to give him a lot of unpleasant sensations. You will learn about what diaper dermatitis is and how to deal with it from this article.
What it is
Diaper dermatitis is an inflammatory process on the skin, a localized advantage in the most piquant places - in the perineum, in the sacrum, in the tender femoral and gluteal folds, in the groin folds of the skin. This inflammation worries both the child and his parents quite strongly. The rash can be minor and quite extensive, have the appearance of separate rashes or merge into one large eczema, it can be both dry and weeping.
To combat this phenomenon, which affects six out of ten Russian babies, and in violation of the hygiene rules of care, even all ten, mankind invented disposable diapers, however, this only slightly reduced the number of skin diseases.
Diaper dermatitis remains one of the most common complaints that parents turn to their pediatricians.
Why does it arise?
The problem has two main reasons: external stimuli and internal factors. In practice, there is always a combination of both.
Internal reasons
Newborn babies have very thin skin, which does not have such a developed degree of protection as the skin of adults. It is especially sensitive to any effect - temperature, humidity, the presence of pathogenic microorganisms. It absorbs moisture faster, softens, pores expand. This feature of the structure of the dermis is characteristic of children under one and a half to two years. Then the skin becomes denser and less prone to inflammation.
The most susceptible to diaper dermatitis are children who have problems with the balance of beneficial and opportunistic bacteria. Such conditions sometimes arise from prolonged use of antibiotics. Babies with reduced immunity after an illness are also more susceptible to negative local effects on the skin. Children who are genetically predisposed to allergies in general and its skin manifestations in particular, quite often suffer from diaper dermatitis.
External causes
External stimuli are well known and obvious - these are feces and urine. Diaper dermatitis always occurs due to the fact that the baby's skin is in contact with ammonia, which is contained in the urine, with urea. But the most dangerous is the combination of urine and feces, because in this case, the skin is not only injured by the aggressive urine environment, but also infected with opportunistic microbes that leave the intestines along with the feces. Inflammation develops in conditions of a lack of airflow, which is created under a diaper or wet diaper. In such a space, bacteria are much easier to multiply.
The most aggressive is concentrated urine. It becomes so during periods of fluid loss by the body.
If a child is sick, he has a fever, if he sweats, then less urine is released. The less urine, the more concentrated it is.
Another external reason is the mechanical friction of the diaper. Irritation from diapers is quite painful, especially when urine or feces get on them. Feces by themselves can change acidity depending on the child's nutrition and even without urine can cause quite serious skin damage. Children of the second half of the year suffer from diaper dermatitis more often, since the complementary food that mother introduces from about 6 months significantly changes the composition of the intestinal contents, the acidity increases, and the composition of urine, when eating not only mother's milk, but also juices, changes significantly.
Supporting factors
A poor-quality diaper that does not retain moisture well is more likely to cause dermatitis in the intimate area than a good diaper that separates liquid from feces and is impregnated with an emollient balm. But even an excellent and expensive diaper will not save a child from an inflammatory process if parents rarely change it, allow overflow, and also wipe the child when changing a diaper, and not wash it.
Violation of hygiene rules - the most frequent auxiliary factor, against the background of which inflammatory processes develop under the diaper. Moreover, violations include not only insufficient water procedures, but also excessive washing, especially if parents use soap for this every time. Soap dries the skin, makes it more fragile and vulnerable, microcracks are more easily formed on it, in which pathogenic bacteria multiply perfectly.
It is enough to use soap only when the baby has crumpled. If there was no bowel movement, you can simply wash the child with plain water. Overheating also affects the onset of inflammation. If the room is in tropical heat, then the baby is sweating. The temperature is higher under the diaper than outside, therefore, not only urine and feces, but also the salty environment of sweat act on the skin.
Symptoms and Signs
Mothers can easily identify the first symptoms of diaper dermatitis without having any special knowledge in the field of medicine:
- The baby's skin turns red and visually swells. The lesion site may be reddish or deep red, slightly swollen. The inflammation has no clear delineated boundaries, it is blurred.
- Outside the diaper the skin remains clean and healthy.
- Puffiness is unevenly distributed. Where there was the closest contact with urine or feces, hyperemia is more pronounced. Nearby there may be "islands" of perfectly healthy light skin, alternating with other inflamed fragments.
- The inflammation changes all the time. If in the morning the fragments of redness and puffiness looked in a certain way, then by lunchtime they can merge, decrease or increase, change their location.
- "Fresh" inflammations are characterized by the appearance of a small weeping rash. Older foci of inflammation dry out, peel off.
More "picturesque" looks like dermatitis, which is joined by a bacterial or fungal infection. In addition to all the above signs, the lesion sites are covered with serous plaque, a film, eczema with loose edges is formed. With fungal diaper dermatitis, the edges of the eczema may be white or grayish.
In general, the child behaves restlessly, cries, eats less willingly, and sleeps very badly. Pain, itching, tingling increases significantly immediately after the baby pees, and some time after he empties the intestines, provided that he does all this in a diaper. With a large lesion area, inflammation can also affect the mucous membranes of the genital organs - under the foreskin in boys and the labia minora and the entrance to the vagina in girls.
Body temperature may rise slightly if the dermatitis is extensive. Small inflammatory processes are not accompanied by fever.
Diagnostics
The task of the pediatrician is not only to confirm or deny diaper dermatitis in infants, but also to distinguish it from other skin diseases - atopic or allergic dermatitis, seborrheic inflammation or contact dermatitis. These conditions require different treatments with different medications.
Diaper dermatitis is easily diagnosed by its characteristic visual signs. It is more difficult to establish which bacteria or fungus caused the secondary inflammation if there is a fact of an associated infection.
In this case, the doctor scrapes the eczema and sends it to the bacteriological laboratory in order to know exactly what pathogens are and what to fight. If the doctor discovers that the area around the anus is most inflamed, he will definitely ask for a feces test to exclude increased acidity of stool, intestinal infections and parasitic diseases.
Treatment
Treatment of diaper dermatitis always begins with a revision of the parent's approach to hygiene when caring for a child. It is important that the diaper is changed as often as possible, without waiting for it to overflow and swell. After defecation, changing the diaper is mandatory, with the obligatory washing of the child with warm soapy water. Air baths are very useful, so parents often need to remove the diaper from the baby and let the skin "breathe".
Quite often, it is possible to cope with mild diaper dermatitis with only one hygiene and the use of air baths.
With a more extensive lesion, which greatly worries the child, the doctor may additionally prescribe some pharmacy products to correct the care. In the choice of drugs, he will adhere to the rule "wet - dry, dry - moisturize". Therefore, for weeping rashes and moist eczema, drying agents such as talker are usually prescribed. "Tsindol" or ointment "Desitin"... When the skin is dry in places of lesion, mild anti-inflammatory and moisturizing creams are prescribed: "Bepanten", "Drapolen" or for children "Panthenol".
If the doctor determines that a fungal infection has joined the inflammation, then he may recommend nystatin ointment or "Clotrimazole" for topical application. With a bacterial complication - antibiotic ointments. Helps to quickly cure bacterial inflammation "Baneocin" and tetracycline ointment.
Allergy medications are usually not prescribed. If the problem is not resolved within a week, despite the prescribed treatment, then the doctor may advise hormonal ointments, such as "Advantan"... Parents will treat the baby at home, there are usually no indications for hospitalization with diaper dermatitis. From folk remedies, pediatricians fully approve of sea buckthorn oil on dry areas of inflamed skin, washing with chamomile decoction with a weeping rash.
It is categorically impossible to lubricate the inflamed areas of the skin with brilliant green, iodine, sprinkle abundantly with powder. Do not wash the child with a solution of potassium permanganate. It is forbidden to manually remove dried crusts to avoid additional infection.
Tips
- The diaper must be the right size... Disposable panties, which are large or small, only increase the negative mechanical effect on the skin. It is especially important to choose good and high quality nappies for sleeping at night, because the baby is in them longer than during the day. Such hygiene products must have excellent liquid absorption capacity. It is best to opt for diapers with a gel-forming outer layer. All the liquid that gets into them turns into a gel, the skin of the crumbs, even with a long stay in the diaper, does not come into contact with urine.
- For daily hygiene, it is important to use only baby cosmetics and care products. Adult soaps or creams are not suitable for baby skin and, in addition to the prerequisites for the development of diaper dermatitis, they also create an excellent platform for the development of contact allergies.
- When washing, it is important to watch out for so that the stream of water rinses all the folds of the skin, since urine and particles of feces that may remain in them will certainly give an inflammatory process in the most painful place - in the fold area.
- After bathing or washing, you do not need to dry your baby with a towel, since this only increases the possibility of causing micro-trauma to the skin. It is best to gently pat your skin with a clean, dry diaper.
- Opponents of disposable diapers claim that they are harmful and dangerous, especially for boys. This harm is not medically justified and is greatly exaggerated. If a baby growing up in diapers starts to suffer from diaper dermatitis, it makes sense to switch to diapers at least at night.
- The manifestations of diaper dermatitis are stronger in formula-fed children. This is due to the different acidity of feces, which is formed in children who eat formula. To minimize the risks and save the baby from such a nuisance as diaper rash, you need to carefully consider the choice of the mixture itself. It is best if it is fully adapted for children up to 6 months and partially adapted for children from six months.
- If parents prefer to use gauze diapers or reusable panty diapers with fabric or gauze liners, then they should be washed only with baby soap or a special hypoallergenic powder, then boiled for 10 minutes and only then rinsed with chilled, pre-boiled water. This will help reduce the risk of developing inflammation in the groin and genital area.
You can learn more about children's film dermatitis from Dr. Komorowski by watching the video below.
