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Clinician’s Corner: Diaper Rash

This week we continue our discussion of yeast and fungi focusing on Candida albicans, in a different patient population, that is in our infants and diaper wearing toddlers. When we think of the ideal environment for yeast and fungi to grow, we think of warm, dark and moist.  What better place to grow than a baby’s diaper!  Candida albicans is the most common cause of diaper rash in infants. The fungi take advantage of the warm, moist conditions inside the diaper.

Causes of diaper rash:

  • Too much moisture
  • Rubbing and friction
  • Skin contact with urine and feces
  • Allergic reaction to the diaper material or to creams, powders or wipes

Role of Candida albicans:

  • Infection often occurs after 48-72 hours of active eruption.
  • It is isolated from the diaper area in as many as 92% of children with diaper rash.
  • Other microbial agents have been isolated less frequently, perhaps more because of secondary infections.
  • Most babies affected are 9-12 months old.
  • Diaper rash occurs in 1/3 of the population.

Pathophysiology

  • Wet skin increases the penetration of irritant substances.
  • Bacteria release ammonia on the baby’s skin causing irritation. Digestive enzymes may also cause skin irritation.

Prevention

  • Change your baby’s diaper often.
  • Keep the diaper loose enough to let air reach the skin inside the diaper.
  • Gently clean the affected skin with warm water. Pat gently with a clean, soft towel.
  • Don’t use wipes that contain alcohol or perfume.
  • If you use cloth diapers and wash them yourself, use very hot water. Rinse carefully
  • Breast fed babies have less diaper rash because their bowel movements are more acidic.
    • Broad spectrum antibiotics especially for ear infection can cause diaber rash by destroying protective bacteria. Amoxicillin/clavulanate (Augmentin®) and Cefdinir (Omnicef) frequently cause diaper rash.

Your Thompson pharmacist recommends  a barrier ointment  before the first dose of broad spectrum antibiotics, to prevent diaper rash.  For even our smallest patients, your Thompson Pharmacist is a great source of information for prevention of diaper rash.  Go ahead and ask…at Thompson Pharmacy it’s all for you (and the little ones too!)

COMMENTARY

This area of study is of particular interest to me not only as a young pharmacist when we had three kids in four and one-half years, but now that we are blessed with three grandchildren!

Next week we’ll cover the treatment of Diaper Dermatitis