Severe Diaper Rash: Causes, Treatment & Prevention

There’s nothing worse than seeing your little one in pain, and the mum-guilt feelings which accompany this aren’t much fun either. Changing nappies is rarely pleasant – a red bottom makes it even worse.

Unfortunately, diaper rashes are all too common. The American Academy of Pediatrics estimates that over 50% of babies between 4 months and 15 months of age will experience a diaper rash at every two-month period.

Whilst a mild rash is easily manageable, and many times disappears on its own, severe diaper rashes require more attention.

This article provides everything you need to know about severe diaper rashes: the symptoms, treatment, and how to prevent it from reoccurring. Let’s help you out!

What Is A Severe Diaper Rash?

A diaper rash is a condition where a baby’s skin in the diaper area becomes inflamed. It’s characterized by tenderness, redness and a scaly look.

In more severe cases, red bumps will be visible in a larger area, together with peeling and swelling. The peeled area may also bleed.

Apart from these signs on your baby’s skin, there are other tell-tale signs that something’s not right.

Your baby will be fussy, especially when urinating, passing stools, and during diaper changes.

Often, babies will cry when the area is touched, so proper handling can ease some of the discomforts.

As outlined by Medscape, there are three kinds of diaper rashes:

  • Rashes caused by diaper wearing.
  • Widespread rashes with added redness in your baby’s bottom because of the irritation caused by diapers
  • Rashes in the diaper area, unconnected to diaper use.

What Are The Symptoms Of A Severe Diaper Rash?

The following is a list of signs that gives away the possibility of your baby having a severe diaper rash:

  • Deep red raised bumps in the diaper area
  • Discomfort and pain when urinating and passing stools due to inflammation
  • Large area of bottom affected
  • Severe peeling and swelling
  • Bleeding
  • Substantial areas of raised papules
  • Bumps or pustules containing fluid.

Identifying a diaper rash as being severe helps in finding the appropriate treatment for it.

Identifying Diaper Rash

Not all diaper rashes are simply irritation from diaper wearing. In this case, they would require specific treatment too.

AskDrSears outlines the tell-tale signs of specific rashes:

  • Intertrigo: rash within skin folds and places where skin rubs together. It appears red and burn-like.
  • Yeast Rash: yeast from the intestines can invade the skin when this is damaged. Antibiotic use can lead to this rash, as well as prolonged rashes. This kind of rash is characterized by red, raised, patchy skin with sharp borders.
  • Impetigo: the invasion of damaged skin by bacteria. Impetigo leads to coin-size blisters or red raised patches that ooze.
  • Seborrhea: inflammation can affect other body areas, but is most severe in the diaper area. Seborrhea usually shows as a sizeable red demarcated patch in the diaper area and lower abdomen and looks raised, rough, and greasy.
  • Allergy ring: some foods, especially those high in acid, can irritate the baby’s bottom. An allergy ring presents itself as a red ring around the baby’s anus.

Is This Eczema Or A Severe Diaper Rash?

Treating a yeast diaper rash with an eczema treatment can actually make matters worse.

Identifying whether your baby is suffering from eczema or a severe diaper rash is thus important.

Whilst a severe diaper rash looks like a patchwork of red inflamed skin in the diaper area with the possibility of oozing and bleeding, eczema rears its head as tiny red bumps.

What Causes Bad Diaper Rash?

Regardless of the care taken to change diapers frequently and to keep the area clean and dry, diaper rashes can still rear their ugly heads.

Nonetheless, wetness, friction, urine, feces, and microorganisms are the main culprits.

As noted by Medscape, the whole anatomy of the area, with its folds and creases, makes it all the more susceptible to rashes. Here are some causes of severe diaper rash:

Note from Dr. Leah Alexander, M.D., F.A.A.P.: “Eczema is rarely (if ever) seen in the diaper area. This is most likely because the skin stays moist because of the diaper.”

1) Bouts Of Diarrhea

Frequent bowel movements may irritate your baby’s sensitive skin, leaving it more prone to rashes.

2) Ill Fitting Clothes

A size too small will rub against the skin causing chafing and also possibly lead to a rash.

3) Antibiotics

As highlighted by Hopkins Medicine, antibiotic medicines leave babies at higher risk of diaper rash.

The same applies if you are taking antibiotics and breastfeeding.

Antibiotics kill bacteria, both the good and the bad. This means that the bacteria that control yeast growth may be affected leading to a yeast-infection-induced diaper rash.

4) Weaning And New Food

Exposure to new foods can lead to added bouts of diaper rash.

Rather than a full-blown allergy, your baby may have a sensitivity to specific foods.

Food high in acids such as citrus foods, tomato sauce, and juices may make diaper rash more likely.

Apart from the redness in your baby’s bottom, you may also notice redness around the mouth when eating such products.

A Few Issues You Should Be Aware About

1) Introducing A New Product

Thought of giving those new nappies a go?

Not all baby items were created equal and your baby may not react to them in the same manner either.

As noted by Mayo Clinic, baby’s skin can easily react to new nappies, new wipes, or the detergent used to wash cloth diapers.

Keep a tab on the new products introduced so as to easily rule out product-led sensitivity.

2) Yeast Infection

When a diaper rash goes untreated for a number of days, a yeast infection can develop.

A yeast infection doesn’t look nice: it presents as dark red areas on your baby’s bottom with or without raised yellow, fluid-filled pustules that can rupture and flake.

This is what a yeast infection looks like, as presented by Uptodate. (Sensitive photo, viewer discretion is advised).

3) Can Teething Cause Diaper Rash?

Studies have shown that teething and diaper rashes are not related.

Diarrhea, irritation, infrequent diaper changes, a yeast infection and changes in diet can all cause diaper rash, but not teething.

Should I See A Doctor?

Following some simple care routines, many diaper rashes go away on their own.

But, if your baby’s skin doesn’t improve after a few days of home care, consult your doctor.

If the rash looks severe or unusual, gets worse by time, bleeds, itches or oozes, and if your baby cries when passing stools or urinating, then it’s time to head to the doctor.

The same applies if the rash is accompanied by a fever.

If your baby is still less than a month old, then call your doctor if grouped tiny water blisters appear or if the area looks infected.

Your doctor will be able to provide a proper diagnosis and treat a severe diaper rash. You will be advised to keep the area as dry as possible.

What Should The Doctor Know?

Your doctor will ask you a number of questions to understand where the rash is coming from.

Prepare a list of the signs and symptoms your baby is showing, as well as the baby’s recent food intake.

If breastfeeding, keep a tab on any new or acidic foods you may have eaten in the past days.

Medication can also lead to rashes – notify your doctor of any medication you (if breastfeeding) or your baby are taking.

Before heading to your appointment, take a minute and try to recall products, especially new ones, that came into contact with your baby’s skin.

This includes diaper brands, detergents, and soaps.

If you think a specific product may have led to the rash, it helps to show it to your doctor who can have a look at its ingredients.

How Can I Treat My Baby’s Severe Diaper Rash At Home?

The ABCDE of diaper rash treatment can help you manage your baby’s discomfort as well as treat the rash:

A – Air out skin (leave baby without a diaper for a while)

B – Barrier (a proper skin ointment helps ease discomfort and heal the area)

C – Clean (keep babies affected skin clean at all times)

D – Disposable (opt for disposable diapers rather than cloth diapers during this time)

E – Educate (some simple steps to follow at every diaper change can help prevent more rashes)

With diaper rashes, less is more. When treating a diaper rash at home, avoid baby powder and cornstarch. Cornstarch can actually make some diaper rashes worse, especially ones caused by Candida.

There are a number of alternative treatments that seem to help but, with a severe diaper rash, it’s best to consult your doctor before making use of any.

As outlined by Mayoclinic, the following are home remedies that can help ease discomfort and also treat diaper rash:

  • Witch hazel
  • Breast Milk (A study found that treatment with breastmilk was as effective as treatment with a 1% hydrocortisone ointment. Another study noted that breastmilk had such a positive effect that health centers should be educating about it!)
  • Calendula and aloe vera
  • Shampoo clay (a study found that this worked faster than calendula)
  • Evening primrose, a mix of honey, olive oil and beeswax have also been found to help out but this has not been proven. Still, care should be taken as these can promote bacterial growth and make matters worse.

Specific treatment is required for severe diaper rash.

Usually, a topical paste is prescribed. The thickness of paste protects, heals and provides comfort. Such pastes usually contain petrolatum, zinc oxide, karaya powder and moisturizing agents.

If the rash is fungal, your doctor will prescribe an antifungal cream.

If there are symptoms of a skin infection, head to your doctor. Your doctor may prescribe antibiotics to manage the infection and clear the rash.

Airing It Out Without Potty Knowledge

If you think airing out little bottoms when potty training is still far off sounds like a recipe for disaster, then you’re not the only one.

Momsanity offers some tips on how you can manage this with your ‘overall well-being’ – cue, sanity – in place:

  • Get some fresh air in the backyard. Place infants on a water-resistant mat, and let toddlers run around au naturel.
  • Place some toys in the bath and let your little one play to their heart’s content (without the water of course). Accidents? Easily washed away once playtime’s over.
  • Make the most of the time after a wet diaper.
  • Cover floors with absorbent pads

Otherwise, simply embrace the mess, and be ready to clean up. On the plus side, airing a little bottom does wonders in treating diaper rash.

In the long run then, this should outweigh the clean-up stress.

What Is The Best Way To Prevent A Severe Diaper Rash?

Changing diapers frequently, cleaning the area with warm water and patting the skin dry with a clean towel or letting it air dry can do wonders in the prevention of nasty diaper rashes.

Diaper-free time also helps the skin dry naturally.

Avoid scrubbing excessively when cleaning the diaper area.

If your baby is more prone to diaper rashes, use a barrier ointment as part of your diaper changing routine.

The petroleum jelly and zinc oxide in the majority of diaper ointments have survived the test of time in terms of effectiveness.

Your own hygiene is also important – wash hands thoroughly before and after every diaper change. This prevents the spread of bacteria or yeast.

The use of powder is no longer recommended by doctors as this can cause lung irritation.

Last but not least, your baby’s diapers should fit comfortably.

Should I Stop Using Baby Wipes?

Whilst your baby may be sensitive to the brand of wipes you are using, it has been scientifically proven that baby wipes are better than water and washcloth.

A study compared the two and found that wipes are better as water does not provide pH buffering.

Are Cloth Diaper Better?

If you’re thinking of switching to cloth diapers to help prevent diaper rashes, unfortunately, there is no concrete evidence that cloth diapers are better than disposable ones in this regard.

Whilst cloth diapers are heaps better in terms of costs and the environment, there’s no way of saying which is best in terms of rashes.

Whilst some moms did note that their babies experienced fewer rashes with cloth diapers, scientifically, no proof has been found.

Cloth diapers do have fewer chemicals than disposable diapers – this factor can aid in the prevention of diaper rashes.

But, if the detergents used to wash cloth diapers appear to make the situation worse, then opt for ones as natural as possible and aimed at sensitive skin.

Some Laundry Tips You Should Keep In Mind

When using cloth diapers, careful and thorough washing can help prevent diaper rash.

The Mayo Clinic outlines the steps for successful cloth diaper washing:

  • Soak soiled diapers in cold water
  • Disinfect by washing diapers in hot water with mild detergent and bleach. Adding vinegar to your wash cycle helps remove odors and rinse out all soap.
  • Double rinse to remove all chemical traces
  • Avoid fabric softener and those lovely scented dryer sheets – fragrances may easily irritate baby’s skin.

Using Disposable Diapers

Disposable diapers that leave a petrolatum formulation on the skin have been found helpful in this regard.

The extent to how breathable the disposable diaper is also has a profound effect on diaper rashes.

The chances of a candida infection decrease by 38-50% when breathable disposable diapers are used.

Other great disposable diapers are ones that have an insertion which prevents leaks but allows water vapor to go through. This helps keep the area dry.

This method was proven to decrease severe diaper rash by 39%. Next time you’re diaper shopping, it helps to read the fine print!

Nonetheless, in terms of diaper nature, there is no one size fits all, so trial and error will help you get the answer as to the ideal diaper for your baby.

How To Comfort A Baby With Severe Diaper Rash

Seeing your little one in pain is downright – well – painful. One mom provided tips that help ease baby’s discomfort:

  • A bath at the perfect temperature (slightly cooler than normal) helps cool and soothe the area, as well as occupy your child with something else. Do not use fragranced products as they will worsen the rash. Make sure to thoroughly pat dry the area, or leave it to air dry, to avoid adding moisture.
  • Go diaper free for as long as you can; any social events you had planned will be less fun with an uncomfortable baby so rescheduling might be for the best.
  • Soften surfaces where baby will sit or lie down.
  • Use a bigger diaper size to prevent chafing and irritation
  • Invest in an overnight diaper rash protector. Not only will your little one sleep soundly, the rash will hopefully improve by morning too.

How Long Does Severe Diaper Rash Last?

Most diaper rashes go away in two or three days, but some stubborn ones may last more.

If the rash doesn’t go away or reduce in severity after home care, prescription medicine might be needed. This is where you should consult your doctor.

Note from Dr. Leah Alexander, M.D., F.A.A.P.: “I often seen infants who have a fungal diaper rash, have been prescribed an anti-fungal cream, but return for another office visit because the rash persists.

What I have found is that parents are using their usual barrier cream remedies in addition to the prescribed cream.

Most antifungal treatments are dosed once to four times a day, depending on the product.

Candida albicans seems to proliferate in the presence of zinc oxide, cornstarch and petroleum creams, so their use prolongs the candida infection.

In these situations, parents believe that the antifungal treatment is not working. In reality, the problem is everything else they are using.

Therefore, when I prescribe treatment for a fungal diaper rash, I counsel parents to ONLY use the prescription until the diaper rash resolves.”

Can This Be A Signal For Underlying Issues?

A number of rare diseases can lead to recurrent diaper rashes.

Congenital syphilis, histiocytosis X, zinc deficiency, Wiscott-Aldrich syndrome, acrodermatitis enteropathica, and Jacquet’s dermatitis all cause diaper rashes.

Whilst very uncommon, they should be looked into if your little one is experiencing recurrent bouts of severe diaper rashes that seem unresponsive to usual treatment.

Do Toddlers Get This Too?

Toddlers can also experience severe diaper rash.

You might be tempted to change diapers less as the child grows older, but frequent diaper changes are key in preventing rashes.

The causes for diaper rashes in infants also apply to toddlers, so the same prevention methods apply.

Wrapping Up

If you’re asking yourself “Is severe diaper rash a sign that I am doing something wrong?”, then the answer to that is: No, not necessarily.

Diaper rashes are, unfortunately, just another parenthood struggle (along with many others).

Once you get to know the cause of your little one’s flare-ups and identify the best way to treat diaper rashes, managing them becomes easier.

Hold on there. Soon enough you’ll be Googling potty-training and bidding adieu to pesky rashes!

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Medically Reviewed By: Leah Alexander, M.D., F.A.A.P.

Medically Reviewed By: Leah Alexander, M.D., F.A.A.P.

Leah Alexander, M.D. FAAP began practicing pediatrics at Elizabeth Pediatric Group of New Jersey in 2000. She has been an independently contracted pediatrician with Medical Doctors Associates at Pediatricare Associates of New Jersey since 2005. After graduating from Kalamazoo College and Michigan State University College of Human Medicine, she completed her pediatric residency at Overlook and Morristown Memorial Hospitals. She is board certified in General Pediatrics.

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1 thought on “Severe Diaper Rash: Causes, Treatment & Prevention”

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    Great post. Incontinence makes life difficult for many. Finding the right pad can really improve their comfort. Your advice is great for anyone who has never had to deal with the issue before! Thank you for sharing this information.

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