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Red Bottom

Bledermatitis (Latin name)

By Bjarne Lühr Hansen PhD, MD and Philipp Skafte-Holm MD, Mentor Institute

When the skin under the diaper is exposed to irritating chemicals – from urine, faeces and the diaper – it reddens and risk for eczema and inflammation arise. Mild cases of red bottom can be treated at home but a doctor, who can prescribe effective medication, should examine severe cases.

A red bottom is when the skin under the diaper becomes red. Blisters may develop and the skin may tear. The child becomes irritable and may not sleep well at night. A red bottom is not an illness but rather an overall term for a number of conditions that can cause redness, irritation, eczema and inflammation in the diaper area with infants.

Practically all children will – at some point – have a red bottom. Urine and faeces contain chemicals that irritate the skin and also the diaper contains chemicals (colourants) that irritate the skin. Some children are allergic to diapers with colourants. When the warm, moist skin comes into contact with the irritating chemicals, problems may arise. The result is a red and irritated bottom.

If there is contact between the skin and the irritating chemicals over a longer period of time or if the child has particularly sensitive skin, eczema may arise in the diaper area. In the case of eczema, the red bottom will be covered with liquid-filled blisters and the skin may tear. Another complication, in addition to the red bottom, is inflammation. Bacteria from the faeces may cause inflammation. In the case of inflammation, the red bottom will be covered with blisters filled with pus – a sort of pimple. Fungi can also attack the red bottom which will cause even more redness and an even larger area of skin will be affected.

Children with diarrhoea and children with dry skin or infantile eczema have a greater risk of having a red bottom. When the child has diarrhoea, the frequent defecation leads to extra irritability of the skin. Children with dry skin or infantile eczema have especially sensitive skin and it does not take much before the skin becomes irritated or eczema develops.

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Severe cases of red and irritated bottom, with or without eczema, can be treated with a crème containing corticosteroid. The crème can be bought over the counter in a pharmacy.

Inflammation should be treated with a crème containing corticosteroid and antiseptics or fungicides. This crème is only available on prescription.

What can you do?

It is important that the urine and faeces are only briefly in contact with the skin and that the child’s skin is strengthened. Therefore, you must change diaper on a regular basis and always immediately after defecation. Carefully, wash the bottom with cotton wool wrung in water. Avoid the use of soap and products containing irritants. After washing the bottom it is important that the skin is allowed to dry. Thereafter you apply a thick layer of zinc ointment. Diapers containing colourants should be avoided.

Contact the doctor tomorrow

If the child’s red bottom does not improve in the course of a few days. If blisters develop or the skin tears. If you suspect inflammation of the skin.

Contact the doctor immediately

This is never necessary.