Diaper rashes are extremely common in infants and toddlers. They are usually caused by skin irritation from urine and stool and the constantly wet environment in the diaper area. Because yeast live on the skin and like warm, moist environments, they often infect the skin of the diaper area, especially if it is already irritated. Once yeast is causing or contributing to the rash, it needs to be treated with an antifungal medicine or the rash is unlikely to go away.
The same yeast also causes infection in the mouth (thrush) which is common in infants. Babies will often have both thrush and a yeast diaper rash.
What are the symptoms?
- Skin redness in the diaper area, especially in skin folds in the front around the hips.
- The redness can be in patches that are large or small, in any part of the diaper area. Sometimes there are bumps present. There are usually red spots at the edges of the rash.
- Your child may be fussy with diaper changes.
- Sometimes thrush is also present.
- It is more common after antibiotic use.
- Diaper rashes that won’t go away with proper treatment or are not improving are likely to be infected with yeast.
What causes yeast diaper rash?
Diaper rashes are caused by skin irritation and breakdown by the constant moisture in the diaper area, as well as acids and enzymes in the urine and stool. Yeast likes to grow where it is warm and moist, and irritated skin is more prone to infection.
Most newborns become colonized, like everyone else, with yeast at birth or shortly afterwards. (The yeast is Candida albicans, the same one that causes vaginal yeast infections.) It is already on the skin of the diaper area. Antibiotics increase the chances of yeast infections because they also kill the good bacteria that help keep yeast from growing.
How is it treated?
For yeast diaper rashes, you must treat the yeast AND the diaper rash. We cannot stress this enough. Treating only the yeast, without adding a barrier cream on top to protect the skin, will prevent the rash from going away.
- Use an antifungal cream 2-4 times per day. Nystatin is a prescription cream that is very effective.
- Clotrimazole, which is available over the counter (Lotrimin AF, store brands), is equally effective as nystatin.
- Apply the antifungal cream first, then apply barrier cream over it.
- Continue to use barrier cream with other diaper changes when not using antifungal cream
- See diaper rash handout or online article for more treatment options for the diaper rash
How can I prevent my child from developing a yeast diaper rash?
Keep the skin as dry as possible with frequent diaper changes. Avoid wipes with alcohol or other things which may irritate the skin. Avoid scrubbing the skin when changing diapers.
When should I seek further care?
- If the rash is getting worse despite proper treatment
- The rash is not improving despite proper treatment
- Open, bleeding or oozing areas
- A lump or nodule under the skin
- Blisters in the diaper area
