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Understand Diaper Rash: Causes, Role of Hygiene, Zinc & Breastfeeding

Unsuccessfully battling diaper rash ? Distressed over your baby’s sore bottom? Rhetorical these questions are here, but if they were to be subjected to a poll, there would be no shortage of “yes” answers from those caring for the little ones. So prevalent is diaper rash. The nerdy term for diaper rash is diaper dermatitis: the suffix -itis in medical lexicon points to the presence of inflammation, derma has Greek roots and is modern Latin for the upper layer of the skin, the dermis.  It is a distressing condition for both the infant and often red faced mother. Red happens also to be the hue of the rashes on an infant’s diaper area. To many first-time mothers, a case of nappy rash may shake their confidence in their ability to be an adequate mothers and care for the infant. The emotional turmoil from this preventable malady may contribute to the stress of pregnancy leading and may precipitate antepartum depression and postpartum depression.

The public health significance of diaper rash ought be an interesting area of research given the rising incomes globally, and modern lifestyles which appears to favor the convince of disposable diapers (over washable absorbent cotton types of yesterday). It is important that some of the popular disposal diapers are of questionable quality with poor absorbent properties leading to wetness of the baby’s bottom predisposing little ones to nappy rash.

More importantly though, is that absorbency of disposal diapers is hinged  on the use of super absorbent gelling materials whose biodegradability and impact on the environment remains largely unknown. Moreover, with the wider challenge of waste disposal in the rapidly urbanizing 21st century, used diaper disposal is emerging as a key contributor to sustainable living.

Whether you are the Eco-concious type who in light of the raging debate over the Eco-friendliness of biodegradable diapers via-a-vis your regular disposable diapers, chooses to go green when diapering, the crux remains that nappy rash can never be to far from your thoughts given .that it is estimated that your average baby goes through 5000 to 7000 diapers by the time they are toilet trained.

What is  diaper rash?

The suffix -itis, is conventionally used in medical circles to denote an inflammatory process in a body organ or tissue. Dermatitis refers to the range of inflammatory disease process occurring in the body’s largest organ, the skin. When dermatitis occurs primarily as a consequence of diaper use/habits, the term Diaper dermatitis suffices. However, in some literature, other rashes that may have other primary causes but which are worsened by Diaper use are included in the definition.

For purposes of this discussion, the term -Diaper dermatitis- will be used in reference of the former narrower more specific definition. As such, the focus will be on contact induced dermatitis. Also known as nappy rash. A form of dermatitis which can be managed in part by changing poor diaper practices.

Though, diaper rash is the most prevalent of rashes in infancy, with a majority of children expected to suffer at least one episode by the time they are toilet trained (usually at around age 2); Diaper Dermatitis has been wrongfully labeled by street-folk as a tell- tale sign of poor parental skills and child neglect.

This stigma may account for some of the emotional injury  and desperation in parents whenever a child suffers from diaper rash.

This misunderstanding around this dermatitis has led to ill advised mothers combing through lists of purported remedies with little success. Treatment failure is common because the effective management of diaper rash requires the recognition and control of predisposing factors. The use of medical remedies has little chance of success without concomitant control of predisposing factors.

Causes of Diaper Rash

Predisposing factors:

  1. Poor diaper practices such as infrequent changing, poor diaper choice and poor diaper area cleaning practices.
  2. Diarrhea
  3. Zinc deficiency
  4. Recent antibiotic use

The precise science explaining the etiology of diaper dermatitis is an area of ongoing research. However, current evidence points towards an interplay of a myriad of factors:

  • Diaper induced friction, prolonged wetness which leads to maceration ( small skin tears due to softening) of the outer waterproof layer of the skin, the stratum corneum.
  • The presence of microorganisms be they be commensual microorganisms or microorganisms introduced by feces.
  • The other important factor is presence of fecal enzymes ( lipases and proteases)  which participate in the breakdown of urine and feces leading to changes in the ph of skin, an important protective factor, which is an important step in the development of diaper rash.

The key event in developing diaper dermatitis  appears to be the weakening of the skin’s integral barrier by the interplay of predisposing factors mentioned above. Increased hydration of the skin then follows as the skin”s natural defenses are breached leading to inflammation when the baby’s immune system responds to defilement of the skins role as a protective barrier to the entry of disease causing microorganisms.

The Role of Hygiene in Preventing Diaper Rash

Long standing presence of feces and urine contributes to this process. This is because these bodily wastes lead to a rise in ph of skin from the normal of 4.5 to 5.5, particularly when urine is broken down by in situ enzymes. Following assault of the skin’s protective barrier, secondary infection by bacteria such as staphylococcus aureus and fungi such as candida albicans may occur complicating the clinical picture as the rashes get infected leading to a severer forms of nappy rash.

Is there a role for Zinc in the treatment of Diaper Rash

Zinc has been demonstrated to have numerous health benefits as it has a key role in cell division and cellular regeneration. Fast dividing cells – like epithelial surfaces of skin and the gastrointestinal tract lining – have a high turn over compared to other cells e.g. heart muscle cells.  Zinc has been demonstrated to aid the process of cell division which is the predominating physiological event in such cells.

Zinc has thus been of great use in preventing diarrhea in infants and in encouraging the healing of skin lesions by the application of zinc based compounds like bland zinc oxide. Diaper rash may result in skin lesions in infants thus zinc oxide, among other treatments, has a central role in managing diaper rash. Supplementation of zinc is also crucial in avoiding frequent bouts of infant diarrhea which may predispose to diaper dermatitis.

Breastfeeding and Diaper Rash

It is not often that you will find reference to exclusive breastfeeding with reduced risk of diaper rash even in the light of medical research that recognizes this benefit. Breastfeeding is thought to reduce the risk as it is less likely to result in stools with a composition that may be harsh on the baby’s skin.

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