BABY PRODUCTS:DIAPER RASH TREATMENTS.

DIAPER RASH TREATMENTS

Many factors contribute to the initiation of diaper rash, including excess moisture, rubbing and friction, skin contact with urine and feces, and/or allergic reaction to the diaper material or to creams, powder, or wipes. While true diaper rash (irritant diaper dermatitis) is most common in babies between the ages of four and fifteen months, incontinent adults risk developing this preventable skin problem as well, as the chronic use of diapers is the common factor in both population groups. In general, infant skin is much less of an effective barrier than that of children (over the age of three) and adults. Because of the thin, soft, and water-containing nature of baby skin, substances are more easily permeable. Areas subject to a high concentration of moisture and soil provide a favorable environment for bacterial growth. Thus, if these types of irritants remain in contact with infant skin over an extended period of time, a rash may develop. The occlusive nature of a diaper tends to inhibit the evaporation of moisture from the skin surface, eventually leading to skin decomposition and an increase in bacterial colonization. Some bacteria produce ammonia through the degradation of urinary urea, and ammonia can then be used as a nutritional substrate, resulting in the growth of even more bacteria. The added presence of feces may contribute urease, which also degrades urinary urea to ammonia. Ammonia will raise the pH of the skin, and this increase in alkalinity facilitates further bacterial growth. In addition, urine may enhance the irritant activity of chemicals by increasing the permeability of the skin and directly acting as an irritant. Diaper rash, characterized by reddened and warm skin, typically occurs in all areas in close contact with the diaper, including the buttocks, upper thighs, lower abdomen, and genitalia.

While prevention of diaper rash may be achieved by keeping the skin dry, preventing urine and feces from mixing together, and retaining an acidic pH on the skin, most cases of diaper rash are treated with products sold in toothpaste-like tubes or plastic jars obtained without prescription. Nearly all brands are formulated with skin protectants such as zinc oxide (ZnO; used in skin healing; antiseptic properties), petrolatum (a semi- solid mixture of hydrocarbons derived from petroleum), and/or dimethicone (silicone emollient). Other products added to diaper rash creams and ointments might include solvents (e.g., benzyl alcohol), opacifying agents (e.g., glyceryl oleate), lubricants (e.g., mineral oil, cod liver oil), emulsifiers (e.g., ozokerite, propylene glycol), humectants (e.g., sorbitol), preservatives (e.g., benzoic acid, borax, BHA, or methylparaben), fragrances, and additional skin protectants and/or wound-healing products, including allantoin, beeswax, silicone, calamine, kaolin, lanolin, and ceresin (earth wax). Specialty brands may also have added products such as vitamins (e.g., cholecalciferol [vitamin D], vitamins A and D [in cod liver oil], and vitamin E), talc (mineral; provides softness), topical starch (cornstarch), extracts of aloe vera (skin wound healing), Peruvian balsam (skin-healing stimulant; antiseptic), and/or bismuth subnitrate (forms a protective coating over inflamed skin areas). However, some of the above secondary ingredients have been known to elicit allergic reactions in some infants.