Most diaper rash is one thing and looks like one thing, and knowing what that's saves you from treating it as something else for a fortnight.
What the ordinary kind looks like
Diffuse pink or red skin on the parts that touch the diaper, the buttocks, the genitals, the tops of the thighs, with the deep creases noticeably spared, because the creases aren't in contact with anything.
The skin may look slightly shiny or feel warm. It's sore, there's no clear border, and it doesn't have spots scattered beyond it. She may be unhappy at changes and otherwise entirely herself.
That's the common version, and it responds within two or three days to more frequent changes, thorough drying and a thin layer of barrier cream.
| What it looks like | Where | Tell | |
|---|---|---|---|
| Irritant diaper rash | Diffuse pink-red, slightly shiny | Convex areas; creases spared | Improves in days with changes and drying |
| Candida (thrush) | Beefy red, sharply edged, small satellite spots beyond the main patch | In the creases | Doesn't respond to barrier cream alone |
| Heat rash (miliaria) | Tiny clear or red pinpoint bumps | Neck, back, shoulders as well | Follows heat and sweating, not the diaper |
| Seborrhoeic dermatitis | Greasy yellow scale on salmon-pink skin | Creases, and often the scalp too | Cradle cap elsewhere at the same time |
| Eczema | Dry, scaly, intensely itchy | Rarely confined to the diaper area | Elbows, knees, cheeks affected too |
| Bacterial infection | Pustules, yellow crust, weeping | Anywhere in the area | Needs a doctor, not a cream |
Telling it from everything else
Four things get mistaken for it, and each has a tell.
- Yeast. Deep beefy red that goes into the creases and doesn't spare them, with a clear border and small separate spots beyond the main patch. Doesn't respond to barrier cream and needs an antifungal.
- Heat rash. Tiny clear or red pinpoint bumps, and it appears elsewhere too, the neck, the back, the shoulders, and follows the temperature, not the diaper.
- Eczema. Dry, scaly, itchy, often on the cheeks and the backs of the knees as well, and it persists regardless of how often you change her.
- Bacterial infection. Pustules, yellow crusting, weeping, skin that is hot and tender and spreading. This wants a doctor and not a cream.
The creases are the fastest single check you can make. Spared means irritant. Involved means think again.
How bad is bad
A rough scale, and the point at which the answer changes from home care to a doctor.
Mild is pink, dry, intact skin over a small area, and it clears in a couple of days. Moderate is redder, over a wider area, possibly with a few small raised spots, and it wants everything doing properly for three or four days. Severe is bright red, shiny, with broken skin, weeping, blisters or bleeding, and a baby who cries at changes, and that's a doctor.
Any broken skin is the line for me. Once the surface is open it can become infected, and at that point you're treating two things.
The two that overlap here
What it looks like here
Slightly different from the textbook photographs, which are almost all taken in temperate countries.
In this humidity the redness concentrates in the folds of the thighs and the groin as much as on the flat surfaces, because that's where sweat stays and nothing dries. It also arrives faster and recurs more readily, and it often turns up alongside heat rash on the neck and back, which is a good clue that the whole child is too warm. I missed that clue for three weeks. Or maybe four.
So the local version of the advice weights drying and diaper-free time above products. Charles's cleared in four days when I finally made the drying a deliberate step, after three weeks of creams.
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These are the ones not to wait on.
- No improvement after two or three days of proper care.
- Deep red in the creases with satellite spots.
- Blisters, pustules, yellow crusting, weeping or bleeding.
- A fever alongside it, and urgently in a baby under three months.
- Spreading well beyond the diaper area.
- A rash that returns immediately every time treatment stops.
- Any rash that doesn't fade under a pressed glass, which is emergency care now.
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This guide is general information, written to help you understand a topic and ask better questions. It is not medical advice and does not replace your own doctor, midwife or paediatrician. Anything that worries you about your baby belongs with them.