Understand Diaper Rash: Causes, Role of Hygiene, Zinc and Breastfeeding

Unsuccessfully battling diaper rash ? Distressed over your baby’s sore bottom? Rhetorical these questions are here, but if they were to be subjected to a poll, there would be no shortage of “yes” answers from those caring for the little ones.

So prevalent is diaper rash. The nerdy term for diaper rash is diaper dermatitis. Please note that the suffix -itis- in medical lexicon points to the presence of inflammation. Moreover, the word -derma- has Greek roots and is modern Latin for the upper layer of the skin: the dermis.  Thus the disease called diaper dermatitis. Daiper rash is a distressing condition for both the infant and often red faced mother.

Red happens also to be the hue of the rashes on an infant’s diaper area. To many first-time mothers, a case of nappy rash may shake their confidence. They may unduly doubt their ability to be fit mothers and care for the infant. The emotional turmoil from this preventable malady may contribute to the stress of pregnancy. Stress in the period surrounding pregnancy is known to cause antepartum depression and postpartum depression.

The public health significance of diaper rash ought be an interesting area of research. Rising incomes coupled with modern lifestyles appears to favor the convince of disposable diapers (over washable absorbent cotton types of). On a personal level, it’s also important to note that some of the popular disposal diapers are of questionable quality. Some of these diapers have poor absorbent properties. Continuous use of them leads to wetness of the baby’s bottom. Wetness predisposes the little ones to nappy rash.

The Environmental Question Facing Diaper Use

Hitching back onto the ‘social good’ bandwagon, the absorbency of disposal diapers is hinged on the use of super absorbent gelling materials whose biodegradability and impact on the environment remains largely unknown. Furthermore, with the wider challenge of waste disposal in the rapidly urbanizing 21st century, used diaper disposal is emerging as a key contributor of roadblocks to sustainable living.

Whether you are the Eco-concious type who’s disturbed by raging debate over the Eco-friendliness of biodegradable diapers via-a-vis washable diapers, the crux remains that nappy rash can never be to far from your thoughts. This is because it is estimated that your average baby goes through 5000 to 7000 diapers by the time they are toilet trained.

What is diaper rash?

The suffix -itis, is conventionally used in medical circles to denote an inflammatory process in a body organ or tissue. Dermatitis refers to the range of inflammatory disease process occurring in the body’s largest organ, the skin. When dermatitis occurs primarily as a consequence of diaper use/habits, the term diaper dermatitis suffices. However, in some literature, other rashes that may have other primary causes but which are worsened by diaper use are included in the definition.

For purposes of this discussion, the term – diaper dermatitis- will be used in reference of the former narrower more specific definition. As such, the focus will be on contact induced dermatitis. Also known as nappy rash. A form of dermatitis which can be managed in part by changing poor diaper practices.

Though, diaper rash is the most prevalent of rashes in infancy, with a majority of children expected to suffer at least one episode by the time they are toilet trained (usually at around age 2); Diaper dermatitis has been wrongfully labeled by street-folk as a tell- tale sign of poor parental skills and child neglect.

This stigma may account for some of the emotional injury and desperation in parents whenever a child suffers from diaper rash.

This misunderstanding around this dermatitis has led to ill advised mothers combing through lists of purported remedies with little success. Treatment failure is common because the effective management of diaper rash requires the recognition and control of predisposing factors. The use of medical remedies has little chance of success without concomitant control of predisposing factors.

    Causes of Diaper Rash

    Predisposing factors:

    1. Poor diaper practices such as infrequent changing, poor diaper choice and poor diaper area cleaning practices.
    2. Diarrhea
    3. Zinc deficiency
    4. Recent antibiotic use

    The precise science explaining the etiology of diaper dermatitis is an area of ongoing research. However, current evidence points towards an interplay of a myriad of factors:

    • Diaper induced friction, prolonged wetness which leads to maceration ( small skin tears due to softening) of the outer waterproof layer of the skin, the stratum corneum.
    • The presence of microorganisms be they be microorganisms that normally reside on your baby’s skin, or other ‘alien’ ones introduced by feces.
    • The other important factor is presence of fecal enzymes (the eaters of fat – lipases and the eaters of proteins – proteases) which participate in the breakdown of urine and feces. This leads to changes in the ph of skin. Remember that skin pH is an important protective factor. Once the environment of the skin is altered in the above ways, we soon are on the way to developing diaper rash.

    The key event in developing diaper dermatitis  appears to be the weakening of the skin’s integral barrier by the interplay of factors mentioned above. Increased hydration of the skin then follows. Therefore, the skin’s natural defenses are breached. This leads to inflammation when the baby’s immune system responds to defilement of the skin’s role as a protective barrier. Furthermore, once the barrier is breached, entry of disease causing microorganisms follows. Once again, this only serves to accelerate the disease process.

    The Role of Hygiene in Preventing Nappy Rash

    Long standing presence of feces and urine contributes to the baby suffering from this disease. This is because bodily wastes lead to a rise in ph of skin from the normal of 4.5 to 5.5. It must be emphasized that urine is the key driver, particularly when it’s broken down by enzymes. Following assault of the skin’s protective barrier, secondary infection by bacteria such as staphylococcus aureus and fungi such as candida albicans may occur. This subsequently complicates the clinical picture as the rashes get infected. Once the rashes get infected, we are in dangerous territory as we see severer forms of nappy rash.

    Is there a role for Zinc in the treatment of Diaper Rash

    Zinc has been demonstrated to have numerous health benefits. Zinc’s powers come from it’s key role in cell division and cellular regeneration. Fast dividing cells – like epithelial surfaces of skin and the gastrointestinal tract lining – have a high turn over compared to other cells e.g. heart muscle cells. Zinc has been demonstrated to aid the process of cell division which is the predominating physiological event in such cells.

    Zinc has thus been of great use in preventing diarrhea in infants. Moreover, zinc is known to encourage healing of skin lesions. The best way to deliver zinc in healing skin diseases is through application of zinc containing products.

    The safest zinc containing product is bland zinc oxide. Parents need to be careful lest they worsen the nappy rash. This is because some untested products may contain ingredients that cause skin allergies.

    Nonetheless, diaper rash may result in skin lesions in infants. Thus zinc oxide has a central role in managing diaper rash. Supplementation of zinc is also crucial in avoiding frequent bouts of infant diarrhea. When your baby suffers from diarrhea, they’re likely to suffer from diaper dermatitis from the wetness.

    Breastfeeding and Diaper Rash

    It is not often that you will find reference to exclusive breastfeeding with reduced risk of diaper rash. This is despite medical research that recognizes this benefit of exclusive breastfeeding. Indeed, it is true what they say about good news. All the same, breastfeeding is thought to reduce the risk of nappy rash. The reasoning is that breast milk is less likely to result in stools with a composition that may be harsh on the baby’s skin.

    Last Updated on by eastview family healthcare

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