Nystatin

Diaper rash is a common problem that can cause pain and discomfort in many infants and toddlers. Babies, with their naturally sensitive skin and their need for diapers, which collect skin irritants and cause friction, are prime candidates for developing skin irritations in the diaper area. There are various types and causes of diaper rash, and not all cases are treated exactly the same. The condition is characterized by a red rash, which may be flat or raised and can blister when severe. Some children appear to be more prone to diaper rash than others, and while it is certainly uncomfortable, the condition is not typically serious. Most cases clear up after a few days of appropriate treatment.

Types of Diaper Rash

The term "diaper rash" can be used to describe a number of specific diaper area rashes, and treatment may differ slightly from one type to the next.

* Contact diaper rash is a simple diaper rash that is not likely to require prescription treatment in mild to moderate cases. Contact diaper rash typically clears up quickly, and may be prevented with regular application of barrier creams or ointments.

* Impetigo occurs when bacteria begin to grow in skin areas already damaged by rash or irritation. Coin-sized blisters may appear, and this type of rash may have a golden-brown crust oozing from the affected area. Prescription treatment is usually required.

* Inteitrigo is a rash occurring within the skin folds and creases where the skin rubs together in the presence of heat and moisture. It may appear bumpy and red and in most cases can be treated and prevented in the same way as contact diaper rash.

* Seborrhea is a skin condition that can affect other parts of the body, but can be more severe when it occurs in the diaper area. It is characterized by a raised, rough, thick patch of skin, which may be warm to the touch.

* Yeast rash occurs when yeasts, which live naturally on the skin or may come from the intestines, invade the skin of the diaper area. It is common in children taking antibiotics or in cases of prolonged diaper rash. It is a red, raised rash with defined borders, and may have satellite spots outside the main border. A prolonged yeast rash may require a prescription to clear it up effectively, and the use of a probiotic can be beneficial.

Causes of Diaper Rash

There are several causes of diaper rash, and identifying the cause in a specific child may help prevent or minimize its occurrence.

* Antibiotic use: Antibiotics kill both bad and good bacteria, and without the proper balance of good bacteria, yeast infections can develop. Use of a probiotic during treatment and for several days after can maintain that balance and reduce the risk of yeast infection.

* Bacterial or yeast infection: The warm, moist nature of the diaper area can create a breeding ground for bacteria and yeasts, which thrive under such conditions. These rashes often start within the creases of the skin and move outward. Frequent changing is a primary means of prevention, and using a barrier cream regularly can be of help.

* Chafing or rubbing: Tight fitting diapers or clothing that rubs against the skin may cause a rash, and can worsen an existing one.

* Introduction of new foods: When solid foods are introduced, the content of the stool changes, which may increase the likelihood of developing diaper rash. Some breastfed babies develop diaper rash as a reaction to something highly acidic eaten by the mother. Delaying the introduction of solids can reduce this risk, as can a nursing mother's careful monitoring of her diet.

* Irritation from stool or urine: Prolonged exposure can irritate a baby's sensitive skin. Frequent diaper changes (particularly dirty diapers, which are more problematic than wet ones) may help to limit outbreaks of diaper rash.

* Reaction to products: New diapers, wipes, powders, or lotions may cause a rash in the diaper area. Other possibilities include detergent, bleach, or fabric softener used to launder cloth diapers or diaper covers. Selecting dye-free and fragrancefree products may help reduce the likelihood of developing diaper rash.

Treatments for Diaper Rash

There are a number of prescription and over-the-counter treatments available for diaper rash. A compounding pharmacist can advise the caregiver which treatment is best, except in cases where the condition is severe. In severe or prolonged cases, the caregiver should be advised to consult a physician.

Over-the-Counter Treatments

* Acid mantle works by restoring the skin's natural acidity, relieving dryness and irritation.

* Acidophilus and other probiotic supplements may be taken orally to prevent the occurrence of yeast rash, as appropriate.

* "Butt paste" is generally prepared by a compounding pharmacist, and includes a combination of boric acid, Peruvian balsam, and zinc oxide in a petrolatum base. It treats diaper rash quickly and effectively and may also be used as a preventive measure.

* Lanolin ointment or cream is very soothing to sore bottoms and can be used regularly as a barrier. A well-known brand name is Lansinoh.

* Zinc oxide cream is excellent for treating mild to moderate rash, and creates a barrier for prevention. Brands with zinc oxide as their primary ingredient include Desitin and Balmex.

Prescription Remedies

* Antibiotic ointment may be prescribed to treat impetigo.

* Cholestyramine ointment is available only as a compounded prescription. It works by binding up bile acids and pulling them away from the skin. This remedy is suitable for mild to severe rashes, and improvement often can be seen within a few hours.

* Clotrimazole is an antifungal agent available in both prescription and overthe-counter strengths, and it may be compounded in a zinc oxide or lanolin base. This treatment is used primarily for yeast rashes.

* Hydrocortisone cream is available in both prescription and over-the-counter strengths, and is often used to treat seborrhea but should not be used to treat yeast infections.

* Nystatin is another antifungal agent. It may be compounded into a diaperrash-friendly base according to a doctor's specifications to treat stubborn yeast rash.

* Triamcinolone is another corticosteroid cream often prescribed to treat severe diaper rash. It can be purchased commercially or compounded with zinc oxide or lanolin.

Other treatments or combinations may be available from a compounding pharmacy, and some doctors have their own preferred protocol for treating diaper rash. To aid in the healing of diaper rash, a compounding pharmacist may advise the caregiver that it would be helpful to allow the problem area to breathe by avoiding plastic diapers and tight-fitting clothing.

Shannon Fields, BA

Innovative Pharmacy Solutions

Edmond, Oklahoma

Address correspondence to Shannon Fields, BA, Innovative Pharmacy Solutions, 1716 S. Kelly Avenue, Edmond, OK 73013. E-mail: shannon ©innovativepharmacy.com

Copyright International Journal of Pharmaceutical Compounding Nov/Dec 2005
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