Diaper Rash: Five questions answered by Dermatologist

As a first time parent, one is perennially busy  changing diapers especially during the first year. The bottom involves special care as the skin is delicate and exposed to a lot of irritants and cleansing. We often see lot of parents complaining about the diaper rash in their children.Here are a few commonly asked questions that I encounter in my daily practice. I have shared the answers and some useful tips to avoid diaper rash.

Q-1) How do I clean the diaper area of my baby?

Ans . This is the most important of all the steps to prevent diaper rash. There are a few basic precautions like

1. Always clean the area from front to back, especially in girls to prevent urinary tract infections from the faecal bacteria near anal canal.
   
2. Never try to pull apart the foreskin in boys which is fused for the first two to three years.
3. Make sure to clean the creases and the folds making sure that there is no hint of moisture left. Moisture is a breeding ground for infections.
4. Please use a sheet whenever you change the diaper in public places to prevent transmission of infections.
5. Air drying is better than pat drying. The latter is still preferred over rubbing or not drying at all.
   
6. DONOT use wipes which contain alcohol or fragrance. The wipes should be used only when cleaning with water is not available. Minimise their use as much as possible.
   

Q-2) What causes rash or ‘eczema’ on  my baby’s bottom?

Ans- Multiple factors predispose this area to irritant diaper rash. Prolonged contact with faeces, urine and repeated cleaning disturbs the sensitive skin in this area, hence causing rash. Improper cleaning practices or neglect can cause diaper rash.

Q-3) What should I do to treat the diaper rash?

Ans- First and foremost try to adopt proper cleansing practices as outlined above.

1. Avoid using harsh soaps and hot water. Prefer a gentle cleansing lotion ( pH of around 5.5) to a soap bar.
2. Prefer washing the area with cleanser and water than a wipe whenever possible.
3. Apply a skin moisturiser first followed by a barrier cream. The latter which generally contains zinc oxide in higher percentage forms an occlusive film to prevent contact of the skin with faeces.

This should be done at every diaper change.

Q-4) Should I prefer a cloth diaper or disposable ones?

Ans- Actually a disposable diaper is preferable to cloth diaper. The cloth diaper should be promptly changes once soiled. The disposable diaper can be changed every four hours or so. There is no difference in rash if either is used.

Q-5) Will changing the type of diaper help my child?

Ans- The chances of getting a rash are same for all the types whether stick–on type or pant sized diapers. The only type of diaper that is slightly better than others is the one which are superabsorbent as they can be used for a slightly longer duration.

As a Dermatologist and a first time parent, I was bewildered too while making the right choice for my child. I hope this addresses few of those doubts and concerns. Please feel free to ask any queries related to the diaper rash and I shall be happy to help you.

Stay skin healthy and skin wise!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

Dry skin or Atopic Dermatitis in children

I see a lot of parents in my practice who are anxious and worried about the recurring dry skin of their children or Atopic Dermatitis. This not only is a cause of concern but can be a distressing condition for the children as well. In this blog post on pediatric dermatology, We shall discuss the causes and care required for alleviating the discomfort associated with this under recognized but important skin condition affecting children. I would be glad to answer your queries and comments.

Q – What is the cause of dry skin of my child?

Ans – Our skin has a ‘brick and mortar’ arrangement where the skin cells are the bricks and they are fused with each other by “Natural Moisturizing Factors’ (NMF). NMF is made up of free fatty acids and Ceramides. It is believed that deficiency in this NMF leads to ‘Dry Skin condition’ or “Atopic Dermatitis”. Atopic dermatitis simply can be put as ‘an itch that rashes’. It includes a tendency to have allergies at places where body is in contact with the external environment like allergic rhinitis, hay fever and eczemas.

Q – What are the risk factors for atopic dermatitis?

Ans- A positive family history of similar dry skin, asthma, hay fever or eczema can predispose the children to this condition. It is more found in urban areas than rural. It is largely believed that a cleaner environment and healthier diets to pregnant mothers exposes the child in utero to very few infections. As a result of which their immunity is hyperactive and shifts to a tendency for allergies. (HYGIENE HYPOTHESIS”).

Q – What can I do to alleviate my child’s discomfort?

Ans – There are a basic set of precautions and special care that I advise my patients to reduce the frequency and severity of dry skin in children.

a)      SHORT Bathing time – reduce the shower time to less than five minutes.

b)     SOAP USAGE – Minimal application of soap to the entire body and choose a moisturizer containing soap. (For further reading read my blog on this link ).

c)      LUKEWARM water – instead of very hot water. Water and soap further dry and reduce the lipid layer of ski , hence they aggravate the condition.

d)     MOISTURIZE with a recommended moisturizer within three minutes of bath after gently patting the skin dry. Don’t handle skin in a rough manner at all.

e)      CONTACT with woolen garments, fur and dust should be minimized.

f)       COTTON or LINEN garments should touch your child’s skin.

g)      MINIMIZE things which catch dust like carpets and soft toys around your child.

h)     PREFER vacuum cleaning at least once a month.

Q- Which moisturizer should I use for my child‘s skin?

Ans- Moisturizer is the lifeline to prevent this condition as they seal the fissures and improve the disturbed barrier function. They are of different types-

a)      Emollients - They are naturally found in palm and coconut oil. They replenish the natural moisturizing factors. Shea cocoa butter containing products belong to this category.

b)     Occlusives- They serve to seal the gaps between skin cells and make skin ‘slippery’. They are greasy, messy and have allergic potential.  Petroleum jelly is an ideal example. I would rank them lower in my choice of moisturizers. 

Q- What is an ideal moisturizer?

Ans - Patients who are confused by media hype often ask this question. The ideal moisturizer should be:

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Q – Which type of moisturizer do you recommend?

Ans – The following is a quick guide for choosing a moisturizer     

1)Moisturizers designed for the face are typically non-greasy, non-comedogenic emollients, with an emphasis on skin feel and aesthetics with maximal skin benefits.

2) Silicone derivatives in particular are targeted for consumers with oily skin. Kaolin and Talc containing compounds are good for oily skin.

3) Moisturisers marketed as anti ageing should include sun protectants, alpha hydroxy acids (e.g., glycolic acid), and retinol and its derivatives.

4)Prefer lotions for day time use while creams are thicker and should be applied at night.

5)Emollients containing moisturisers like shea butter , squalene should be preferred for very dry skin over body and hands. Avoid them on face as they can trigger ‘acne’ or ‘pimples’.

Q- Which oil should I use for my child?

Ans – Coconut oil has been shown to improve the skin barrier which is deficient in atopic children. Olive oil and other oils are harmful than helpful for skin.It has been proven by studies that the barrier function is best restored with the coconut oil. Coconut milk is equally desirable.

Atopic Dermatitis tends to improve with age. It should not cause unnecessary anxiety and concern. There are simple and effective treatments available which can remit or at-least maintain results. Consult your dermatologist today for daily skin care regimen. 

Stay skin healthy and skin wiser!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion

Seven things you must know about Baby's skin care

A common worry that bothers all parents is the care of baby's skin. In my new post I try to capture the frequently asked questions on skin and hair care for babies. 

I will start by explaining the skin structure in very simple language and then explore how to take care of baby's skin and hair.

Q 1 – How is the skin of my child different? Does it require some extra effort and then so, Why?

Ans -The skin of an infant is different from adults in many ways which is crucial for understanding the skin care regimen for the parents -

                   

Skin  Structure of Newborn	Implication for skin care
a)           Higher skin surface area to weight ratio (skin surface area of infant is 700 cm2/kg as compared to adult skin which is 250 cm2/kg) .	a) Increased absorption in the blood of topical preparations (applied products)on the skin.
b)           Connection between the upper layers  of skin (epidermis and dermis) is not very strong	b) Blisters can form easily.
c)           The skin barrier is not fully developed	c)More susceptibility to infections and allergic reactions AND Increased water loss from the skin
d)           Smaller  and inactive sweat glands	d)Decreased sweating , more possibility of heat rash or prickly heat
e)           Acidic pH of the skin	e) Any increase of pH can increase bacterial colonization of the skin.

Q2-Doc, which soap should I use for my Baby?

Ans- Most of the soaps contain surfactants ( Read More here) which can have harmful effects on the skin of the newborn-

1. They deplete the lipid part of the skin barrier hence making it weaker
2. Increase the pH of the skin hence increasing the risk of skin infection
3. Denature( destroy) skin proteins further weakening the skin barrier.

Q3- What are the alternative for soap ?

Ans-  Cocoyl isethionate,sodium lauryl sulphate, and betaines are examples of synthetic non soap detergents (syndets ) which retain the normal pH of the skin but can be drying. Such syndets with addd moisturisers like mineral oil , paraffin and glycerince are most suitable. Soap free cleansers should be preferred but in smaller quantities. Soaps which produce more foam are HARMFUL for your baby's skin.

Q4 – When should I start applying soap to my baby?

Ans- Minimal use in first few months.

Immediately after birth, skin pH may be >6.0 which  falls to 4.95 after birth. This protective “acid” mantle protects against pathogens. Any  soap application will raise the skin pH from acid to neutral hence  increasing the total number of bacteria and increased moisture  loss. Regeneration of skin pH takes at least an hour after washing with alkaline soaps.  If at all needed, healthyterm newborns and infants can be washed MINIMALLY  using cleansers of neutral or slightly acidic pH, which have a gentle surfactant, be chemically and physically stable, and should contain an emollient. BOTTOMLINE is MINIMAL use of soaps in the first month of age.

Q5 – How should I wash  my baby's hair?

Ans -  Shampoos should have minimal time of contact with the scalp to avoid irritant dermatitis. The shampoo should be free from fragrance, anti-inflammatory agents and natural products. Most baby shampoos in the market contain anionic surfactant which ensures adequate cleaning. The pH of the shampoo should be close to the a that of tears and should be non-irritating to the baby’s eyes.

Q6- What about the napkin area of my baby?

Ans- The diaper area is probably the most frequently washed area of the baby.

Cleaning the nappy area "Front to back"

1. Regular nappy/diaper change is a must as baby’s stool and urine can macerate the skin of your baby if in prolonged contact.
2. “Baby wipes”- they also should be alcohol and preservative free. Consult your Dermatologist for recommendations.
3.  Always clean the area from front to back with soft cotton cloth or towel.
4. Apply a  Bland moisturiser and a barrier cream containig Zinc Oxide for skin protection if prolonged Diaper wear is required.( Use Dermatologist /Pediatrician recommended Diaper rash creams) 

Q7- What precautions I should take while washing my Baby’s clothes?

Ans-  You should use gentle detergents for washing your baby’s clothes.

1. Avoid  adding antiseptic solutions or cleansers ( e.g Dettol etc.). They are VERY HARSH for your baby’s skin.
2. The detergent should be fragrance free
3. Rinse the detergent thoroughly. (MACHINE WASH IS BETTER THAN HAND WASH)
4. Donot add Fabric Conditioners/Bleaches
5. Prefer cotton and linen waer for your baby
6. Wash any new dress before making your child wear that.

I have tried to touch the most commonly asked questions about Baby Cleansing. Please feel free for comments/queries and spread this message across for Better skin care for our children which they truly deserve and desire. This will be followed by How to tackle dry skin in children. Happy Reading!!! Stay skin healthy and skin wiser!!

Dr Divya Sharma is a practicing dermatologist at Bangalore. The data shared in this blog is her personal opinion based on her knowledge and experience. The author is not responsible for any adverse event that arises out of following blog opinion