Diaper rash

Disease Description (Causes and Symptoms)

• Disease name: Diaper dermatitis (Diaper [napkin] dermatitis). This is a clinically widely used term.
• Causes and pathophysiology: Prolonged moisture, friction, irritants contained in urine and stool (such as ammonia and digestive enzymes), and pH changes damage the skin barrier, reducing its primary defense and causing inflammation. Candida (fungal) infection or bacterial infection may occur secondarily.
• Main symptoms: Erythema, rash, itching, vesicles, erosion (peeling), and exudation (oozing) on the buttocks, genital area, lower abdomen, and pubic area. The deep folds of the groin are relatively less affected.
• Diagnostic points: Diagnosis is based on the typical distribution of lesions and clinical findings. If Candida infection is suspected, consider a KOH direct smear (fungal examination), or antifungal treatment if clinically there are predominantly patch-like lesions with prominent satellite lesions. If a secondary bacterial infection is suspected, antibiotic treatment is determined based on a smear/culture or clinical findings.

Treatment Methods

• Basic principles (non-pharmacological care)
  • Change diapers frequently to keep the skin dry and clean (changing within 2 hours is recommended if possible).
  • When soiled, gently clean with mild water or physiological saline without rubbing.
  • Provide airing time frequently (remove the diaper whenever possible).
  • Applying a barrier ointment (such as zinc oxide or petroleum jelly) when changing the diaper is recommended.
  • Avoid irritant detergents, fragrances, alcohol, powders (talc), and similar products.
• Medication treatment
  • Mild cases: Management primarily with barrier ointments (zinc oxide, petrolatum).
  • In cases of severe inflammation: Use a low-potency topical steroid (e.g., 1% hydrocortisone) for a short period (generally 3–7 days)—in children and infants, follow the doctor’s instructions regarding the medication and duration of use. High-potency steroids are contraindicated.
  • If Candida is suspected or confirmed: Apply topical antifungals (such as clotrimazole, miconazole, or nystatin).
  • If a secondary bacterial infection (such as pustules or impetigo) is suspected: Administer a topical antibiotic (such as mupirocin) or, if necessary, an oral antibiotic.
  • For acute lesions with severe exudation, dry the area with a wet dressing (water compress) before applying topical treatment.
• Precautions, complications, and self-care considerations
  • Avoid prolonged or extensive use even of mild steroids (due to concerns about skin atrophy and systemic absorption).
  • Seek medical attention immediately if there is no response to treatment, the lesions worsen or spread, high fever or systemic symptoms occur, or vesicles or pustules develop.
  • Recurrent or relapsing lesions require differentiation from other conditions such as allergic contact dermatitis, atopic dermatitis, Candida infection, and psoriasis.
• Prognosis: With appropriate care, symptoms generally improve within several days to 2 weeks. If infection or an underlying disease is present, the treatment period may be prolonged.

Checklist Before an Outpatient Visit (Items to Prepare and Example Questions)

• Items to prepare (bring to the visit)
  • A list of medications currently being taken or used (especially topical ointments), or the medication packaging.
  • The date symptoms began and how they have changed over time (photos can be useful).
  • A record of fever, loss of appetite, and other systemic symptoms.
  • Information about the type of diaper (disposable/cloth and brand), diaper-changing frequency, and detergents and lotions used.
  • A history of atopic dermatitis, sensitive skin, or fungal infection.
• Information that may be helpful to provide to the doctor during the visit
  • When symptoms appeared and factors that worsened or improved them (e.g., dietary changes or antibiotic use).
  • Treatments already attempted at home (medications, ointments, or other treatment methods) and their effects.

Examples of General Questions to Ask the Doctor

• What are the main side effects of this ointment (medication)? How long is it safe to use?
• What care methods can be performed at home (such as diaper-changing frequency and how to use barrier ointment)?
• If these symptoms recur, are additional tests or evaluation by another specialty (e.g., pediatrics or dermatology) needed?

Examples of Condition-Specific Questions

• What tests are needed to determine whether this rash is caused by Candida (fungus)? Is a direct smear (KOH) test necessary?
• If a steroid ointment is needed, what potency should be used, and how often and for how long should it be applied?