• Dr Andy Raffles

Nappy Rash

WHAT CAUSES NAPPY RASH?

Nappy rash is a very common condition affecting up to a third of nappy-wearing babies, whether disposable or non-disposable nappies are used. It is caused by a baby's delicate skin coming in contact with irritating chemicals in urine and stools, and skin irritation resulting from rubbing against the fabric of the nappy.


It can be seen as the baby’s skin becomes sore and irritated in the area around the nappy, covered in pink, red spots or blotches. Most nappy rashes are mild and can be treated with a simple skin care routine. Some nappy rashes are more severe and can be complicated by an associated fungal or bacterial infection. Severe rashes are painful and require treatment. Nappy rash usually, but not always spares the folds of the skin in the groin and buttocks, and if the skin in these areas is inflamed this may suggest infection with thrush or streptococci.


For mild rashes it is best to leave the nappy off whenever possible and to change the nappy as soon as it is wet or soiled. Highly absorbent nappies are more efficient then towelling nappies, but also tend to make the skin hotter due to the plastic waterproof outer cover on a disposable nappy.


Avoiding the use of soaps and only using water to clean the nappy area helps avoid dry easily irritated skin. The skin should be well dried with a soft material. Drying should be by dabbing the area , rather then rubbing. A barrier cream is useful every time the nappy is changed. Zinc cream, zinc oxide ointment, petroleum jelly are all suitable creams. Talcum powder must not be used because it does not protect and can cause friction and irritate the skin further.


Severe nappy rash needs medication. It presents as bright red spots, dry, cracked, broken skin, swellings, ulcers or blisters over a larger part of the nappy area and may spread down the legs or up to the abdomen. The baby may cry and be irritable. Topical corticosteroids reduce inflammation of the skin: Hydrocortisone cream is applied to the baby's skin once a day and usually stopped when the inflammation has settled – which may take seven days. Topical antifungals are often applied simultaneously because candidal ( thrush) infections are often associated. These creams are applied to the nappy area with each nappy change, and not less than two to three times a day and for 7 days after the rash has healed. The skin may become infected by a bacteria and this may be associated with fever. The skin can then present with blisters and collections of pus and is painful. These babies need to be treated with antibiotics.


Some babies are very prone to nappy rash, others less so. Usually when your baby gets unwell, and especially with diarrhoea illnesses the nappy rash can be quite severe , and initially resistant to treatment. Teething also seems to trigger nappy rash in some infants.

Other causes of rash: In rare cases, the nappy rash may be caused by an underlying condition:

  • Eczema

  • Seborrhoeic dermatitis

  • Allergic dermatitis

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