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The Hows and Whys of Diaper Rash

Diaper rash (more properly “diaper dermatitis”) is common in the US, with up to 2/3 of full-time diaper wearing babies having at least some rash. Because diaper rash is a dermatitis (skin irritation), and not primarily an infection, prevention is far better than having to treat the rash once it develops. Diaper rash is caused by irritants and excess moisture trapped under the diaper that impair the skin’s healthy acid barrier, triggering increases in skin pH, inflammation and chaffing. The rash that forms creates a cycle of increasing skin pH and more irritation in the diaper area, causing a “perpetual breakdown of the skin barrier with subsequent inflammation and activation of the skin’s repair response”.

All redness in a baby’s “down under” isn’t necessarily diaper rash, it can also be from yeast infections, eczema, or psoriasis. These conditions also associate with higher rates of diaper rash, suggesting that babies with recurrent diaper rash should see a healthcare provider who knows to look beyond the diaper rash, just in case.

Lower skin pH can prevent diaper rash, as it improves the barrier structure of skin and the mucosal health of the urogenital tissues (vaginal and penile). It also reduces activate fecal enzymes at the stool‐skin interface that cause irritation. This low pH allows growth of a healthy microbiome (good bacteria) which suppresses bad bacteria related to diaper rash progression.

References

Int J Womens Dermatol 2019 Mar 3;5(4):233-234
Skin Res Technol 2021 Mar;2; 7(2):145-152.
BMC Dermatol 2020 Sep 21;20(1):7 ¼-1/3 J Eur Acad Dermatol Venereol 2020 Jul;34(7):1516-1523.
Am J Perinatol 2018 Apr;35(5):486-493.

We need to acknowledge that although widespread, this rash isn’t normal.

There is a lot of advice out there about how to prevent diaper rash, but rigorous randomized clinical trials are lacking, with the studies of studies (meta-analyses) relied on to make informed choices, mostly only able to suggest more studies are needed! Diaper rash isn’t a sign of bad parenting or care-giving, in fact it can be more common in groups with more day-time diaper changes and more wipe use.

To prevent diaper rash, we need to acknowledge that although widespread, this rash isn’t normal. In a 2020 study, only 1/3 of full-time diapered American babies didn’t have rash symptoms.

A few care-giving approaches seen in babies without diaper rash, who had a healthier skin barrier and lower pH included:

  • breast feeding (lowers baby’s poo and diaper pH area),
  • less frequent use of wet wipes, including not using a wipe for a urine-only diaper
  • decreasing overnight diapers from 8-9 hrs to 6 hrs
  • spending more undiapered air time

Things that didn’t help prevent diaper rash or that were associated with more rash included:

  • higher number of diapers used during the day
  • use of wet wipes for urine-only diapers
  • frequent bathing

References

Pediatr Dermatol 2020 Jan;37(1):130-136.
Pediatrician 1987;14 Suppl 1:21-6.
Am J Perinatol 2018 Apr;35(5):486-493.

Avoiding common potential allergens in personal care products including wet wipes

Healthcare provider groups are starting to recognize that acidic, gentle cleansing can help prevent diaper rash, such as that provided by Wouche Away™ when sprayed on not yet wet (we prefer organic reusable or disposable dry wipes). However, many wipes and cleansers still have too high a pH, and most are not isotonic or balanced in salts to the human body. Many ingredients in wet wipes are reported by Dermatologists to be potential allergens. And numerous studies report (including from the World Health Organization) that these ingredients harm the sensitive mucosal cells of the vagina, penis and rectum, as well the healthy bacteria that protect our sensitive tissues. This includes “natural” type products such as glycerin, aloe vera, citric acid, and sorbic acid. Sadly, when individuals become allergic to these compounds, dermatitis in their genital and rectal region can increase by up to 15-fold versus non-allergic people and kids.

Data is not sufficient for a clear determination of the value of barrier creams to prevent diaper rash (Aquaphor, Desitin etc…). Some studies have found no benefit, a few small studies found some benefit with low evidence, and in one study, babies in NICU treated with a diaper cream (even if they had no diaper rash), ended up with a 3 times higher incidence of rash than babies not exposed to these products. Studies of vaginal and rectal mucosal cells have found that many of the ingredients and oils in these barrier creams cause mucosal cell damage, harm healthy bacteria and increase vaginal infection by 8 -fold. This causes concern for their use regularly as a preventative in babies for diaper rash. Taking a page from a recent meta-analysis that found baby moisturizers don’t prevent eczema, increase the risk of infection (by changing skin pH), and may increase life-long food allergies, these same effects may come into play with daily use of “barrier” ointments.

Dermatologists are helping to make folks aware of common potential allergens in personal care products including wet wipes that have gone under-recognized.  Researchers in vaginal health are showing us ingredients that harm sensitive urogenital and rectal tissues.  We combined this knowledge to invent Wouche Away to create a safer diaper changing system, to help prevent diaper rash before it starts. Our soothing, prebiotic Wouche Away used with our reusable or disposable dry wipes is a game-changer in mild baby care, one our family uses. (Read testimonials)

References

Adams & Kashuba, 2012 Best Pract Res Clin Obstet Gynaecol Aug;26(4):451-62.
Am J Perinatol 2018 Apr;35(5):486-493.
Arriaga-Gomez  et al., 2019 Int J Mol Sci Oct 28;20(21):5361.
Ayehunie et al., 2011 Toxicology. Jan 11; 279(1-3): 130–138.
BMC Dermatol. 2019; 19: 7.
Cochrane Database Syst Rev 2021 Feb 5;2(2):CD013534
Dermatitis May/Jun 2019;30(3):207-212.
Dermatitis Nov/Dec 2017;28(6):353-359.
Dermatitis Jan/Feb 2017;28(1):64-69.
Food Chem Toxicol 2017 Aug;106(Pt A):107-113.
Int J Womens Dermatol 2019 Mar 3;5(4):233-234
Gali et al., 2010 Antimicrob Agents Chemother. 54(12):5105-5114.
Hu et al., 2016 AIDS research and human retroviruses.;32(10-11):992-1004.
Journal of Women’s Health Jan 2020; 29: 65-73
Lebe et al., 2004 Pharmacology Oct;72(2):113-20.
Moench et al., 2010 BMC Infect Dis. 10:331.
Pediatr Dermatol Nov-Dec 2014;31(6):683-91.
Tabatabaei et al., 2019 Front Dent. 16(6): 450–457
https://www.dermnetnz.org/topics/irritant-contact-dermatitis/