Two basic kinds of diaper rash will be discussed. Mechanical breakdown of the delicate skin around the genitals and anus is caused by frequent exposure to urine and stool. The skin may become red, dry, and wrinkled (prune-like). This is best handled by using bottom barriers discussed below. Occasionally, a child develops a fungal diaper rash, from yeast, which colonizes the bottom from the digestive tract. Yeast is commonly found in the stool. As it remains in contact with the skin, it causes a splitting of the cells of the skin and a very painful, fiery rash develops around the buttocks, genitals, the inner parts of the thighs, the grooves of the groin, and on the skin up to the belly button. For fungal diaper rash (see photo), apply Nystatin cream (100,000 U/gm; prescription) three times a day for seven days. Remove the diaper during naps and at bedtime and have the child sleep on a layer of towels instead of just a sheet in the crib. Exposure to air keeps the skin dry and aids significantly in the healing process.

Sometimes the skin around the genitals will appear a little red and maybe even prune-like, from repeated exposure to urine and stool. In this case, Desitin, A&D Ointment, or Balmex would work as a barrier to the moisture in the diaper. Any of these products works rapidly and facilitates healing. Apply product with each diaper change or as needed.

Any commercial baby wipe brand is fine as long as it is unscented and lacks alcohol. Since disposable diapers are ultra-absorbent, baby wipes are usually unnecessary after urination. Be careful not to overuse wipes, as their tendency is to strip the skin of its natural oils, increasing the risk of diaper rash.