If the erythematous papules spread over the nappy region or if open, weeping areas and crusts appear, this indicates a secondary infection. Common pathogens are Candida albicans as a trigger of nappy thrush or Staphylococcus aureus. Babys between the ages of nine and twelve months are most susceptible. During this time, parents often wean them off breast milk and complementary foods usually play a major role. Typical risk factors for nappy dermatitis are also changing nappies too infrequently, excessive hygiene and unsuitable cleaning and care products. Diarrhoea, acidic or spicy foods and certain medicines such as antibiotics can also promote the development of the condition.
A sore baby’s bottom is caused by an interplay of irritating, enzymatic and microbial factors in the warm and moist nappy environment. A tight-fitting and tightly sealed nappy does not let out urine or stool, but it is a strain on the skin. Not only is it mechanically stressed when the nappy chafes, the occlusion effect also impairs its natural barrier function and makes it more permeable. This makes baby’s skin more susceptible to infections with bacteria or (yeast) fungi, which find optimal growth conditions inside the nappy. Another problem is irritating substances from stool and urine. Even modern absorbent materials cannot completely prevent the skin from coming into contact with the excreta.
Recommendations for the prophylaxis and therapy of nappy dermatitis were summarised in 1999 by the US-American dermatologist Susan Boiko using the first five letters of the alphabet, i.e. ABCDE, as an acronym. The A to E criteria are still considered the therapy standard today and are based on avoiding occlusion effects, protecting baby’s skin and cleaning it thoroughly on a regular basis, optimising nappy care and educating parents about the skin disease. A = air: Baby’s bottom needs air. The skin can recover during diaper-free periods. B = barrier: The natural skin barrier is the best protection. Parents can strengthen it with suitable care products. C = clean: A clean nappy not only makes the baby feel comfortable, but also protects the skin from contact with irritating substances from urine and stool. When changing nappies, parents should carefully clean their baby’s bottom. D = diapers: The ideal diaper (nappy) should absorb urine quickly and at the same time be breathable and preferably also sustainable. Most of the time it remains a compromise solution. If intolerance reactions occur, a change of nappy brand is advisable. E = education: In the case of nappy dermatitis, professionals such as the paediatrician, midwife or pharmacy team can educate and give tips on treatment and prevention.
If sores have already formed, the classic zinc oxide accelerates healing (as in Dentinox® zinc ointment, Dialon® zinc ointment or Retterspitz® zinc ointment). Zinc oxide has a weak disinfecting effect and binds moisture. Preparations with a high zinc oxide content, such as in Weiche Zinkpaste DAB (soft zinc oxide paste), form a protective barrier and keep aggressive components from stool and urine away from the skin. They work well during periods when the skin is very irritated or when baby’s bottom needs to be protected from watery diarrhoea. Outside of these phases, however, they can be harmful if they impair the nappy’s ability to absorb and thus increase the damp climate.
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