What is Diaper Rash
Diaper rash (diaper dermatitis) is an inflammatory skin eruption occurring in the diaper-covered area of infants and toddlers, resulting from prolonged exposure to moisture, friction, elevated pH from urine, fecal enzymes, and microorganisms. 1, 2
Clinical Presentation and Distribution
- Diaper rash manifests as erythematous inflammation affecting the convex surfaces of skin under the diaper, including the buttocks, genitals, and thighs 2
- The condition notably spares the diaper area in atopic dermatitis, which helps distinguish it from other inflammatory conditions 3
- Lesions may range from mild erythema and dry skin to more severe presentations with papules, erosion, crusting, or weeping 4, 1
Pathophysiology and Contributing Factors
The development of diaper rash involves multiple interacting mechanisms:
- Excessive hydration and occlusion from prolonged contact with wet diapers compromises the skin barrier 1, 2
- Elevated pH from urine activates fecal enzymes (lipases and proteases) that directly damage the skin 1, 2
- Friction from the diaper causes mechanical irritation and trauma 2, 5
- Microbial overgrowth, particularly Candida albicans and Staphylococcus aureus, frequently colonizes affected areas and exacerbates inflammation 1
- Infants with atopic tendencies or sensitive skin demonstrate increased susceptibility 4, 5
Types of Diaper Dermatitis
The three most common presentations include:
- Chaffing dermatitis from mechanical friction 1
- Irritant contact dermatitis from chemical irritants in urine and feces 1
- Diaper candidiasis from fungal overgrowth 1
Assessment for Complications
When evaluating diaper rash, look for signs of bacterial infection (crusting or weeping) or fungal infection, and identify aggravating factors such as exposure to irritants 4. Seek medical evaluation for appropriate antimicrobial treatment if infection is suspected 4.