Beyond The Coat

Moms and Dads – this may be the most generally useful post I write.   Let’s talk diaper rashes.  Last week, I was explaining a diaper care regimen to my daycare provider for a nasty rash my son had and I realized that the information I know from treating rashes in the hospital is helpful, but not readily available.  So here’s diaper rash tips and tricks from a Dr. Mom.

The “Yeasty Rash” Care

First, there is the ‘yeasty’ diaper rash.  This rash is red and splotchy and has little red spots that seem to be outside of the area of the main part of the rash.  This rash is itchy and older children may scratch at it.  This type of rash loves damp and moist skin.  You know – like kids in diapers.  This is the type of rash that heals well with ‘airing’ out.  If you don’t have the luxury of letting your little one run around in their birthday suit, you will probably have to ramp up your arsenal to an anti-yeast type of cream or ointment.   If you are in a pinch and it’s bad, you can try over the counter creams for vaginal yeast infections such as Monistat.  Try to find one that is cream or an ointment and only apply it to the external skin area (don’t use it as you would for a vaginal infection in an adult).  Personally, I haven’t had much luck with this method and always opt to go to my pediatrician and ask for an anti-yeast cream called Nystatin.   It’s cheap and generic and works great.  I always have some on hand.  

The “Broken Skin” Rash

Next is the rash that results from the dreaded diarrhea.  It’s terrible, am I right?    As oncologists we obviously give a lot of medicines.  One unfortunate side effect of some of the medicine is diarrhea.  Our poor babies’ bottoms can get so sore to the point where the skin is broken down and there are sores or blisters in the area.   When that happens, we call our wound specialist team.  

Yes, you read that correctly.  “Diaper rashes” can become legitimate wounds and when that happens they need wound care!  This is exactly what happened to my son.  He had areas of skin that were broken down and raw. He was crying, miserable, and sleeping poorly.   

Now, as an adult, I haven’t had a diaper rash like this so I can’t say how it feels.  However – when I was in medical school I ran my first marathon and OMG the chafing!   At mile 19, I poured water over my head and it was then that I realized that my legs had been chafing and when the water hit that area it brought tears to my eyes.   For days, that area stung and burned when it contacted water.  I cannot imagine what it would feel like if it was urine or loose stool.  So, I’m just gonna assume that these diaper rashes hurt at least as bad as this, but likely worse.  Don’t be afraid to use tylenol or ibuprofen to relieve the pain if they are old enough. 

Read on for the best regimen I stole from our wound care nurses.  The key to getting this sad broken down skin to heal is to keep moisture off of the area from multiple angles. 

The “Broken Skin” Rash Care

If you are starting with clean skin, straight from the bath then just pat the area dry with a soft towel and let air dry and skip to STEP 2.

STEP 1: Clean area gently with some saline wipes.  I recommend saline wipes over regular baby wipes or even the ‘water wipes’ because as I mentioned – water stings on open wounds!  If there is still cream from STEP 4 on the area – remove only the cream that is soiled.   Do not try to wipe everything off.  If the cream you have put on at the previous diaper change is still there and intact, then the skin underneath is protected.  For saline wipes, I use these boogie wipes because I always have them in the house.  

STEP 2: Let the area dry completely.   If you use disposable diapers, they make great fans to dry the booty.  In this next step you want to help create a barrier from any external water (poop or pee) getting onto the skin.  This spray below creates a “second skin” that blocks moisture.  It doesn’t sting and it’s great.   My son would laugh when I sprayed it on.  Let this dry completely (it’s pretty fast) and then move to STEP 3 or STEP 4. 

STEP 3 (OPTIONAL): If the area has open sores that are ‘oozing’ that clear fluid that happens with any sore, then you also need to keep that moisture off of the skin also and the spray above and the paste below does no good because the moisture is coming FROM the skin.   This stoma powder is used to absorb fluid that comes from the wound.   Sprinkle this around the area and concentrate on the areas that have any open sores. This powder is very different from baby powder or talc powder.  Do not use those, you’ll end up with a cakey mess. 

STEP 4: The paste.  The point of the paste is to create a THICK barrier to prevent any urine or stool from getting to the skin.   This is the best barrier cream that I have found and we use it in the hospital.   It has sort of a gritty texture, but don’t be alarmed by that.  You aren’t rubbing the cream in, you are layering it on.  Put as thick of a layer on as you can.   This way when the next diaper change comes, you will be able to just take the top layer off that is soiled as I mentioned in STEP 1.   This “take the top layer off” advice works well sometimes and sometimes if they have been moving around a lot or sitting, the cream tends to rub into the diaper.  

There it is – a four step diaper change regimen.  I know, you needed to add more steps to your day, right?  Diaper rash care takes meticulous attention.  I  also know it is a struggle if your kids are in daycare.  I wasn’t afraid to drag this all in and in two days we were on the way to healing!

All of this (except Nystatin) is over the counter.  I didn’t put links, because I didn’t want anyone to think I get any sort of kickback from these products.