Diaper inflammation (diaper dermatitis, diaper eczema or diaper rash) unfortunately occurs very frequently in babies. And this does not necessarily have anything to do with a lack of hygiene! A mild cold with increased body temperature, for example, leads to more concentrated urine – and thus to skin irritation. Teething, a change in diet, diarrhea, treatment with antibiotics or a hypersensitivity (allergy) to care products are also possible triggers.
Breastfed newborns are less likely to have problems than babies who are bottle-fed. Their stool contains fewer bacteria that can cause diaper infection. But once formula is added, the likelihood of diaper eczema increases in all babies. Feces and urine now contain many more bacteria, and that irritates the skin. However, as babies get older, their skin also becomes more resistant. The rash gradually improves and eventually disappears altogether. Most babies are most susceptible between the ages of 7 and 9 months.
Some babies tolerate a sore bottom without changing in behavior. But most react with irritability, frequent crying, and even loss of appetite.
With diaper soreness, you see skin irritation with redness and possibly weeping. Papules may also appear, which are red indurations that protrude slightly above the skin level. Beginning in the diaper area, in more severe cases the irritation may extend to the thighs and into the skin folds of the legs. The skin appears swollen, cracked, scaly or wrinkled. In some cases, an odor of ammonia is noticeable, caused by skin bacteria that break down urine to produce ammonia. Ammonia burns the skin, so the rash can be very uncomfortable for your baby. In boys, the rash may extend to the penis. They will then have difficulty and pain urinating. If the diaper rash is very severe, the skin may even peel off, leaving scars.
If the diaper rash with redness, pimples or pustules, and scabs first appears in the area around the anus and then spreads to the bottom, your baby probably has a fungal disease (thrush, caused by the fungus Candida albicans). You will often see open blisters that have a white ruff around the edge. It is also typical that this so-called candidiasis almost always first colonizes the skin folds, which tend to be left out in a normal diaper infection. If your nipples feel sore and burn at the same time, this is also a clear indication of a fungal infection. Ask your doctor and, if necessary, have a cream or ointment prescribed for treatment.
If the rash is greasy and less red and more yellowish-brown, it is probably cradle cap (seborrheic dermatitis).
Less commonly, infants may also have impetigo contagiosa, a contagious bacterial skin infection caused by bacteria (mainly group A streptococci). Red papules and honey-yellow, purulent pustules are found mainly on the face, but more rarely once in the diaper area. Treatment is with an antibiotic ointment.
Frequent diaper changes and outdoor activities can prevent red pustules. If diaper dermatitis has already developed, there are various treatment options.