At first, diaper rash remedies may seem pretty straightforward. Keep the area dry, apply a diaper balm you love, and before long all will return to normal.
Except, when it doesn’t.
Years ago when my first baby was a few weeks old, I visited with a mama whose baby girl has a persistent red diaper rash and was on antibiotics, then antifungals. At the time, I suggested a Chinese herbal ointment (I stand by that suggestion, more below).
But since then, I have also learned a few things about diaper rash remedies that I would like to share today.
Here’s everything you ever wanted to know about diaper rash, fecal enzymes, and skin pH.
What is a diaper rash?
The official name for diaper rash is diaper dermatitis. It includes any inflammatory skin disorder around the diaper area. And that’s where things (and remedies) can get confusing.
For example, you would take a different approach to manage a diaper rash caused by allergies versus one caused by yeast.
Besides the obvious rash, signs of diaper rash include:
- Prolonged periods of crying
- Changes in sleep
- Less frequent urination or bowel movements
Baby skin is different
The skin of a baby is dramatically different than that of an adult. The outermost layer of skin on a baby is thinner and has smaller keratinocytes (cells that protect things in the environment like heat, UV rays, bacteria, yeast, and water loss). There’s greater cell turnover. And the skin ecology – the microbes living on baby’s skin – is very unstable.
This is worth mentioning since the cause of diaper rash is a breakdown in the skin barrier.
Prolonged wetness around the diaper area weakens this barrier, making it more susceptible to irritation from diaper friction, enzymes from your baby’s stool, or infection.
Enzymes in baby’s stool
I am often asked about acidic foods – such as tomatoes or citrus – and whether or not these can give baby a diaper rash.
These foods aren’t so much acidic, but they do increase baby’s histamine load. What’s the consequence of too much histamine? Signs of allergies, rashes, and eczema – for starters. You can read more about that here.
But, how about that diaper rash.
Rather than acidic foods, start thinking about enzymes.
Here’s why: Your little one’s stool contains enzymes that break down fat and protein. These are major irritants to delicate baby skin.
And this is where acidic urine comes into play: The pH of urine activates enzymes. But it’s not acidic urine that’s the problem – it’s alkaline urine with a high pH.
Acidic urine with low pH also aids skin microbes, supporting a strong and healthy skin barrier. A rise in pH (a more alkaline environment) favors the overgrowth of Candida yeast, which is a pretty common infection in diaper rash.
Kinda like the vagina.
In both cases you want the area to be slightly acidic and filled friendly skin microbes.
This doesn’t necessarily mean swabbing your baby’s bum with probiotics: Some gut microbes make enzymes that start the breakdown of urea (found in urine) into ammonia, making the pH of the skin more alkaline and more irritated.
Which is less than amazing, since we want a strong barrier and baby’s skin to be slightly acidic.
Diet and baby’s pH
Many folks eat a high-veggie diet in an effort to be more alkaline and produce alkaline urine. And it’s true: Vegetables, legumes, and citrus will help urine pH lean a little high. So will a urinary tract infection.
Whereas a diet rich in meat (go, meaty minerals!) and cranberry juice will keep urine acidic. This is a good thing.
And how about before solids?
There is some research suggesting that breastfed babies have a reduced risk of getting diaper rash. The stool of breastfed babies has a significantly lower pH as well as low enzyme activity. This means that it can be less irritating than the stool of formula-fed babies.
Major types of diaper rash
The number one cause of diaper rash is prolonged contact with urine and feces. But what keeps it going – or what turns a basic diaper rash into a blistering red sore – has to do with the things mentioned above. Namely, excessive wetness, elevated pH, lots of enzyme activity, and friction.
Once the skin barrier breaks down, there a greater chance of yeast overgrowth. Other common types of diaper rash involve allergies and eczema. Here are the four most common types of diaper rash.
1. Basic diaper rash
Otherwise known as irritant contact dermatitis, a basic diaper rash is caused by irritation of the skin from a dirty diaper.
Because alkaline urine is thought to make diaper rash worse, things like formula or infection can raise the pH and trigger a diaper rash.
When you spy a basic diaper rash:
- Check diapers every 2 to 3 hours to make sure there’s as little contact as possible with stool and urine. If you can, enjoy diaper-free time with baby.
- Gently cleanse the area with warm water and baby wipes. You generally want to avoid harsh soaps however you also want to make sure your little one is clean, so use a cleanser for sensitive skin like this one from Baja Baby.
- Opt for gentle wipes that are free from alcohol, fragrance, irritants, or sensitizers.
- Apply a thick ointment after cleaning up your little one. Lately, I have been loving this non-nano zinc oxide ointment from MADE OF. I’m also a fan of Earth Mama diaper balm. Look for a product that’s EWG verified or ranks a 1 on the Skin Deep Cosmetics Database.
- If you use cloth diapers, consider switching to a disposable diaper until the rash has cleared.
2. Yeasty diaper rash
Candida overgrowth looks like raw, bright red patches that might be surrounded by smaller red bumps. Candida usually goes into the folds of the skin (it likes warm, moist places).
In order for a yeasty diaper rash to develop, the skin barrier needs to break down. This means that a basic diaper rash is usually a prerequisite for Candida to take hold.
Usually, you want to avoid antibiotics unless absolutely necessary because antibiotic use might cause loose stools or diarrhea, making the diaper rash worse. And relapse after using the antifungal nystatin is common.
To resolve a yeasty diaper rash, I’ve found it’s most effective to use an herbal antifungal ointment. Many natural diaper balms contain antifungal herbs and may help to resolve Candida overgrowth on their own.
I generally like to go a step further and use Chinese herbs because they work and they’re safe for baby’s skin.
Spring Wind makes two antifungal ointments. The original ointment is good for red irritations and exceptionally soothing.
Whereas their Golden Yellow ointment has more anti-fungal herbs and I use it for a stubborn diaper rash that may look red and shiny.
It can also clear up ringworm, boils, staph, poison oak, herpes, and even help with mastitis.
When using for diaper rash, keep in mind that it can stain clothing.
3. Allergic diaper rash
Sometimes a diaper rash is more about the diapers or wipes that you’re using, which can trigger an allergic response.
The culprits are usually fragrances, preservatives, and emulsifiers.
This type of diaper rash is known as allergic contact dermatitis and it tends to show up when new products are introduced.
An allergic diaper rash will pop up anywhere the product in question has been applied, so this is something you can test. It looks like red, raised, scaly skin, and will be in areas where the skin has come into contact with diaper dyes or that have been cleaned with baby wipes.
It can initially take one to three weeks for the allergy to show up. And once you have removed the trigger, it might take two to four weeks for the rash to completely disappear.
Allergic diaper rash is itchy. To make baby more comfortable and clear up the rash, I would apply Earth Mama’s soothing diaper balm with each diaper change.
4. Cradle cap diaper rash
Yes, this exists!
Otherwise known as seborrheic dermatitis, this type of rash looks red and you will see greasy scales. Cradle cap is usually found on the scalp, face, ears, and neck. But it can show up in the diaper area too.
The cause is thought to be an overgrowth of yeast on the skin, knowns as Malassezia. And rather than a harsh antifungal, there’s solid support for the use of squalane oil.
If there’s a family history of psoriasis or if the rash continues past baby’s first 12 months, your primary care provider may want to consider psoriasis because the two look so much alike.