DEAR DOCTOR,

My new-born (one month) has a stubborn diaper rash that seems to be getting worse. I try to leave her diaper free so it can dry up but once I get her to wear one again, it gets worse. What am I doing wrong? Is there any home remedy or even pharmaceutical option I can try to stop it? HOLLY

DEAR HOLLY,

Diaper rash usually occurs due to the skin being damp for some time. If the baby has passed urine and or faeces, after which the diaper is not removed immediately and the perineal area wiped and dried, it can result in diaper rash. Use of diapers with rough, thick material, synthetic material also causes irritation of the very soft skin of a one-month-old baby, leading to redness, painful rashes which may or may not be itchy.  Fancy nylon underpants, very tightly tied diapers or underpants also harm the baby in the same way, resulting in diaper rash. Some body care products, particularly those with chemicals, may cause allergy and irritation of the skin of the bottom, causing rashes.

There may be one or multiple factors involved in causing diaper rash. Whatever the reason, it does cause pain and discomfort to the baby. Moreover, there is real risk of secondary infection occurring over the rash, manifesting as painful boils, with or without fever. Persistent or recurrent skin infection carries the risk of causing generalised infection in the baby, as her immune system is still very weak. This becomes a serious condition. Hence, it is very important to prevent diaper rash.

Prevention lies in keeping the entire bottom area, very clean and dry. As far as possible, diaper should be removed as soon as it is soiled. Wipe the area very gently with a soft tissue or soft cotton cloth, before putting another diaper. If possible, let the baby be without a diaper for an hour or so. This allows the local skin to be well aerated, which is soothing for the new born and helps in preventing diaper rash as well. Diaper used should always be of soft, cotton material and comfortable, that is, not very tight. Avoid using body care products, like baby soap, cream, and et cetera, which contain chemicals. You can stop using a product for three to four days and then restart it. Observe, if by stopping it, rash is cleared and reusing it again causes the diaper rash to appear, it means that product is most likely causing allergy, irritation of the skin and rash. 

Daily bath of the baby should continue. Use of pinch of baking soda in bath water or in the water used to clean bottom when changing diaper, helps in soothing the skin and due to its alkaline effect, prevents growth of bacteria. Aloe vera is a natural antiseptic and applying its juice directly or as ointment is beneficial in both preventing and treating diaper rash. Honey is also useful in this regard. 

Persistent or recurrent diaper rash indicates that either the factors causing rash are persistent or some mild persistent infection has occurred, which needs to be treated. It is advisable to consult a child specialist, if the rash is persistent. 

 Dr. Rachna Pande,Specialist in internal medicine rachna212002@yahoo.co.uk