Diaper Rash—Child Care and Schools

What is diaper rash?

Red and irritated skin in the diaper area can have several causes, with the most common being fungal infections, bacterial skin infections, irritant contact dermatitis, and seborrheic dermatitis.

• Fungal diaper rash is caused by a yeast called Candida and often occurs naturally or after antibiotic use.

• Bacterial diaper rash is caused most commonly by Staphylococcus and Streptococcus species.

• Irritant contact dermatitis results from prolonged skin rubbing against a wet, soiled diaper.

• Seborrheic dermatitis does not have a clear cause but may be linked to a fungus called Malassezia.

What are the signs or symptoms?

• Redness in the diaper area.

• Fungal

  • – Rash is worse in the skinfolds (creases) within the diaper area.

  • – Red, dark or decreased pigmentation/lighter areas often bordered by red pimples ("satellite lesions").

  • – Rash may have a shiny appearance.

  • – Sores or cracking or oozing skin present in severe cases.

• Bacterial

  • – Bright red or dark skin that may be warm, swollen, and tender.

  • – Oozing, yellowish crusts or fluid-filled blisters.

  • – Shiny or moist patches.

• Irritant contact

  • – The rash spares the creases and emphasizes areas in contact with the diaper (inner thighs, genital areas, and buttocks).

  • – Absence of satellite lesions.

• Seborrheic

  • – Red, greasy scales in diaper area. May also be located on scalp, face, ears, and neck.

What are the incubation and contagious periods?

• Incubation period for fungal diaper rash: Unknown.

• Contagious period: The yeast and bacteria that cause diaper rash are commonly found in the environment, on the skin, and in the mouth and stool. Candida diaper rash may occur with or after antibiotic use. Recurring or severe Candida diaper rash could signal immune problems.

Candida rash with typical spread of affected skin to thighs and abdomen in a male infant

CENTERS FOR DISEASE CONTROL AND PREVENTION

Male infant's genitalia and surrounding area with a shiny red rash spreading across the skin, expanding to the inner thigh crease and onto the abdomen, which is affected by pimples and white spots.

Pink and red patches that involve the skin in the diaper area that are characteristic of candidal diaper dermatitis. Scaling skin and spreading to the thighs and abdomen are present.

AMERICAN ACADEMY OF PEDIATRICS, COURTESY OF DANIEL P. KROWCHUK, MD

Male infant's genitalia, thighs, and buttocks with pink and red patches bordered by scaling skin completely covering the genital region and expanding out to the thigh crease.

How is it spread?

• Yeast and bacteria.

  • – Candida is present in the intestinal tract and mucous membranes of healthy people.

  • – Staphylococcus and Streptococcus species are present on the skin of healthy people.

  • – A warm environment (eg, diaper area) fosters growth and spread.

• None of these causes of diaper rash are spread from one child to another.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Fungal diaper rash: Treat with an antifungal cream to lower yeast levels to a manageable level for the body to control. Avoid unnecessary use of antibiotics.

• Bacterial diaper rash: Keep the skin clean and dry. Health professionals may recommend a topical ointment or topical antibiotic if symptoms are more severe. Use a barrier diaper cream to protect the skin from moisture.

• Irritant contact dermatitis: Keep the skin dry and minimize irritation caused by diaper or clothing friction. Avoid scented soaps or wipes, as they can worsen irritation. Frequent diaper changes, air exposure, and reducing friction from clothing or diapers against the involved skin may help promote healing.

• Seborrheic dermatitis: Treatment with antifungal cream or shampoo may help.

What are the roles of the educator and the family?

• Report the condition to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts the parents/guardians so they can seek treatment for the child.

• Administer prescribed medication as instructed by the child's health professional.

Exclude from educational setting?

No, unless

• Oozing sores leak body fluids outside the diaper.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition).