What causes diaper dermatitis in newborns?

Neonatal diaper dermatitis is when the baby's buttocks are irritated by urine or feces, causing redness of the skin, or rashes, ulcers, etc. If not treated or handled in time, it will have a great impact on the baby's health. So what causes neonatal diaper dermatitis? This is an issue that many parents are concerned about. Let’s learn about it together.

What causes diaper dermatitis in newborns?

1. Causes of disease

1. Diaper texture and untimely replacement. Rough diapers or diapers made of rubber cloth, oil cloth, or plastic make the local skin often wet or soaked, and are not replaced in time. Rubber or plastic can sometimes act as an irritant and trigger the disease.

2. If diapers are not washed properly, residual urine stains and feces can be easily decomposed by putrefactive parasitic bacteria to produce ammonia substances, which irritate the skin and cause this disease. Dyes and residual soap on diapers can also serve as irritants and trigger this disease.

3. Infection by pathogens.

2. Pathogenesis

1. Primary irritant diaper dermatitis

(1) Epidermal maceration and weakening of the skin barrier function are the basis of the disease:

① Hydration: Contamination from urine and feces, non-breathable diapers and clothing, etc., increase local skin temperature and sweating, causing the skin to be in a continuously humid environment, promoting skin hydration and ultimately leading to maceration of the epidermis.

② Friction: The friction between the rough diaper and the skin or the friction between the skin causes further damage to the immersed epidermis, which eventually leads to a decrease in the barrier function of the epidermis and the formation of an environment for bacterial growth. Clinically, it is found that children are more susceptible to this disease in the friction areas such as the protruding parts of the vulva, buttocks and waist.

(2) Secondary effects of a series of stimuli:

① Feces: Long-term contamination of newborn skin with feces is the most likely factor for this disease. Proteases and lipases, acidic or alkaline components in feces can further damage the skin barrier. Alkaline stools are seen in children who are fed cow's milk or high-protein foods; acidic stools are seen in children whose diarrhea is caused by soy milk or infection, because the loose stools contain more fatty acids during diarrhea. Clinically, it has been found that once the diarrhea stops, the child's diaper dermatitis will also improve.

② Urine: Ammonia in urine (produced by ammonia-producing bacteria breaking down urea in urine) and the alkaline solution environment further damage the skin barrier and aggravate the skin's inflammatory response. It was wrong to regard urinary ammonia as the primary irritant of diaper dermatitis in the past. It is now believed that urinary ammonia will only irritate the skin when the skin is damaged.

③Chemical irritants: Frequent contact or use of chemical irritants such as deodorants, preservatives, bleach in diapers, disinfectant soaps, creams and oils are directly harmful to the child's skin. In addition, children's skin has poor tolerance to many antifungal drugs.

④ The excessive growth of Candida albicans and anaerobic bacteria will further aggravate the skin irritation reaction.

⑤ Temperature: Increased skin temperature in the diaper area will cause vasodilation and aggravate the skin's inflammatory response.

2. Candidal diaper dermatitis

(1) Source of the bacteria: The bacteria may come from the birth canal of a mother with candidal vaginitis. For breastfeeding mothers, the breasts should be checked for mastitis. Also, check the nipple for contamination by candida. If the child has persistent and recurrent thrush in the mouth, the Candida albicans in the diaper area comes from the child's gastrointestinal tract.

(2) Ask the child whether he or she has a recent history of frequent use of broad-spectrum antibiotics.

(3) Children with diarrhea are more likely to be infected with Candida albicans.

(4) Diapers provide a very warm and moist environment for the growth of Candida albicans; Candida albicans can reproduce on the surface of the skin.

(5) Most scholars believe that Candida is a secondary infection based on skin damage. It can penetrate the stratum corneum and activate the complement system through the bypass pathway, inducing skin inflammation.

(6) Some scholars believe that the severity and duration of diaper dermatitis in clinical practice have nothing to do with the type of diaper dermatitis, but are related to the number of Candida albicans reproduction.

What causes neonatal diaper dermatitis? After reading the explanation in the above article, do you all understand it now? For newborns, parents must pay special attention to changing diapers frequently. Some parents who use diapers for their babies should be careful not to fail to change them for a long time, as this is most likely to cause children to suffer from diaper dermatitis.