How do I get rid of this recurrent rash in my baby’s bum bum?

This recurrent rash in the baby’s bum (perineal-front bum and perianal-back bum) is known as diaper dermatitis. In the most common form, it is an irritant contact dermatitis- a skin rash that develops in babies with prolonged skin contact with an occlusive diaper that has both urine and faeces. It is common, and newborns ar susceptible to it because their skin is immature, they feed, poop, and pee frequently, and mums are exhausted with the constant need for diaper changes. First-time mums can be susceptible for this reason. Older infants who don’t usually need frequent changes may be more susceptible due to dietary changes and changes in intestinal micro biodata and stool PH.

A fungal infection - most commonly from candida albicans causing candidal dermatitis is also common. It occurs in babies on antibiotics who stool frequently, and yeast overgrowth in the stools ends up causing an associated irritant dermatitis.

Bacterial infections are next in line to fungal infections for infectious causes of diaper dermatitis- staphylococcal in newborns from colonization of the umbilical cord.

Diaper dermatitis continues to be seen in all ages of infancy; breastfeeding is a protective factor against diaper dermatitis

While other organisms and conditions can lead to diaper dermatitis, the above two are most common and easily prevented with good diaper hygiene- frequent changes, and what we call an A,B,C,D,E- Air, Barrier, Cleansing, Diaper and Education approach

The most important predisposing factor is increased moisture, so Airing the bum is a good way of preventing and treating diaper dermatitis.

For good diaper area skincare, we further advocate topical Barrier creams and emollients both to prevent and treat diaper dermatitis. Favoured options among mothers include petroleum jelly, zinc and castor oil-containing creams, and olive oil among others

Good diaper area hygiene requires regular Cleansing which involves Frequent diaper changes, rinsing urine and faeces off well with water, and dabbing, not rubbing tender skin especially if there is already some skin breakdown.

Diapers should be highly absorbent, and hypo-allergenic

Mothers should be Educated on how to prevent diaper dermatitis and how to anticipate it - e.g, if babies are placed on broad-spectrum antibiotics- frequent diaper changes and good diaper hygiene including skin care should be ramped up.

Sometimes seborrheic dermatitis and psoriasis or an infectious condition may contribute to or exacerbate diaper dermatitis. These babies may require referral to paediatricians, dermatologists and sometimes infectious disease specialists.