There are several categories of causes for diaper rash. First and foremost is "irritant" or "contact" dermatitis. Skin involvement may vary from mild redness similar in character to a sunburn to erosion of the top layers of skin. A characteristic differential point of contact diaper dermatitis from other causes of diaper rash is that it rarely involves the skin fold regions -- therefore, it spares areas not in contact with urine/stool.
Skin infections compose the next most common category of diaper rash. Bacteria (Staph and Strep) and yeast/fungal (Candida) are common causes of diaper rash. Generally both of these types of infections tend to result from a disruption of skin integrity and overwhelming the natural defense mechanisms of skin in this diaper region. Staph and Strep bacterial infections are commonly termed impetigo. Classic descriptions of impetigo include small (1-2 mm) tiny blisters (vesicles) and pustules that tend to easily rupture leaving multiple erosions in a sea of generalized skin irritation. Candida diaper dermatitis also has several distinguishing patterns. The rash is characterized by zones of bright red skin with a series of discrete 2-4 mm "satellite" lesions at the borders of the confluent irritated skin. In contrast to contact dermatitis, Candida is generally only found in the skin folds creases and often around the anal region. Infectious causes of diaper dermatitis can generally be diagnosed by visual inspection alone. If confusion exists, laboratory studies of swabs of the involved areas may be obtained.
Allergic reactions are a less common cause of diaper rash. Commonly proposed allergens are fragrances and components of the diaper and wipes. These regions often have well-defined zones of redness with superficial vesicles and erosions. If the diagnosis of allergic skin reaction is suspect, skin-patch testing may be done to identify the offending agent. This is rarely necessary.
There are very rare causes of diaper rash. Unusual infections, metabolic and nutritional deficiency states, and immunodeficiency states and malignancies can all be implicated. Unfortunately, child abuse (hot-water immersion, extreme neglect to infant hygiene) can also present as diaper rash.
Less often, allergic reactions to the fragrances or other components found in disposable diapers or wipes can cause diaper rash.
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