Medically known as diaper dermatitis, diaper rash is a skin irritation that occurs in the area covered by the diaper. The diaper rash mostly affects babies under 12 months of age. If the rash is caused by Candida overgrowth, it is called yeast diaper rash and the treatment is based on antifungal medication.
Types of diaper rash
The most common form of diaper rash – also known as the regular rash, or diaper dermatitis – is not an infection, but an inflammatory reaction of the skin around the diaper area. The skin becomes irritated due to prolonged contact with urine, feces or various chemicals from detergents. About 50% of babies develop regular diaper rash at one point in time during the first year of life.
The second most common cause of diaper rash is an infection. Candida infection causes yeast diaper rash – or Candida diaper dermatitis – and can develop following a regular diaper rash.
Bacterial infections with Staphylococcus aureus or Streptococcus pyogenes can complicate a yeast diaper rash.
Yeast diaper rash causes and risk factors
Newborns and infants are at higher risk to develop regular and yeast diaper rash, with a peak incidence between nine and 12 months of age.
Candida albicans is a type of yeast that is found normally on the skin in small amounts. When the normal balance between the fungi and bacteria is disrupted, the Candida can overgrow and cause rash in the diaper area. The diaper region is the most affected, because Candida fungi grow best in warm, moist environments. In addition, the diaper may also irritate the skin and cause inflammation.
Treatment with antibiotics is another risk factor for Candida overgrowth, in the form of yeast diaper rash or oral thrush.
Changes in the baby's diet can also increase the risk of diaper rash because diet influences the gut flora and the stool pH.
Changing the diapers less frequently can also promote diaper rash because the skin has prolonged contact with urine and feces, and therefore more prone to inflammation, fungal or bacterial infections.
While yeast diaper rash is not contagious, parents and caregivers have to wash their hands thoroughly after changing the diapers to avoid infections.
Yeast diaper rash signs and symptoms
The yeast diaper rash causes several signs and symptoms, including:
- The skin is swollen, has a red or purple tone, and is covered with small, fluid filled bumps.
- The rash is located near the groin, upper thigh, or on in the genital area, and does not cover large areas of the body, but rather appear in several small spots along the diaper.
- The baby looks uncomfortable, may cry and become fussy.
- The skin is itchy and irritated.
- Severe cases of yeast diaper rash cause severe pain, with open sores that ooze and bleed.
Yeast diaper rash diagnosis
The diagnosis is based on signs and symptoms. The pediatrician will perform a physical examination and ask the parents more details about the duration of the symptoms, and check if the baby received any treatment with antibiotics recently.
In some cases, the diagnosis can be confirmed with a lab test. Lab tests can also be helpful if the doctor suspects a secondary bacterial infection.
How do you know if it is yeast diaper rash or a regular diaper rash?
While consulting a doctor is best to get the right diagnosis, parents can get an idea if the baby’s rash is due to a fungus or from something that irritates the skin.
The yeast diaper rash is red or purple, with small bumps and has a shiny or oozy appearance, while the regular diaper rash leads to a dry, scaly skin without pimples, and is pink or reddish in color.
The yeast diaper rash typically develops in multiple smaller spots on the skin folds in the genital or groin areas, where the regular diaper rash tends to cover larger parts along the diaper, like the buttocks.
The response to treatment also suggests the underlying cause of the rash. The yeast diaper rash improves with antifungal medication and does not respond to regular diaper creams. On the other hand, the regular diaper rash resolves within days with diaper creams.
If the baby also experiences fungal infection in the mouth (oral thrush), the rash is more likely caused by a Candida fungus overgrowth.
Yeast diaper rash treatment
Since a fungus causes yeast diaper rash, regular diaper creams do not help.
- The treatment is based on an antifungal drug, which may be prescribed in cream, ointment or pill form. Nystatin is usually recommended as a first line treatment for three days. If there is limited or no response to nystatin, the doctor may prescribe Clotrimazole, miconazole, or ketoconazole for seven to 10 days.
- Severe forms of yeast diaper rash may require steroid cream.
- Secondary infections with bacteria are treated with antibiotic creams, or in severe cases with oral antibiotics.
Mild cases of yeast diaper rash typically improve within a few days, but it may take up to three weeks to fully clear up the rash.
Yeast diaper rash home remedies
- Good hygiene is essential to prevent skin irritation and infections. The diapers should be changed frequently during the day, and at least once per night to avoid prolonged exposure to urine and feces.
- Superabsorbent, hypoallergenic diapers are recommended to keep the skin clean and dry.
- The skin in the diaper area can be cleaned with water, using a soft washcloth. It is best to avoid wipes based on alcohol or fragrances.
- After applying the antifungal cream, another layer of cream based on zinc oxide, cod liver oil or petroleum jelly can be applied to reduce skin irritation. Click here to view the list of eco-friendly, hypoallergenic diaper cream products verified by the Environmental Working Group (EWG).
Yeast diaper rash is caused by an overgrowth of Candida fungus, and affects mostly babies in the first year of life. The rash is treated with antifungal medication. Changing the diapers often and keeping the skin clean are essential to prevent and manage yeast diaper rash.
Yeast diaper rash is a common skin condition mostly affecting babies aged nine to 12 months old.
Yeast diaper rash is caused by Candida fungus overgrowth.
In addition to antifungal treatment, good hygiene is essential to prevent and manage yeast diaper rash.
National Library of Medicine. Diaper Dermatitis.
Cleveland Clinic. Yeast Diaper Rash.
Environmental Working Group (EWG). Diaper Cream Products.