Nappy Rash
What is nappy rash and what causes it?
Nappy rash is a type of irritant dermatitis - that is, inflammation of the skin caused by irritation from urine and faeces (wee and poo).
Nappy rash is caused by over-hydration and maceration of the skin from urine/ faeces under occlusion. It is more common in babies who wear cloth nappies as they are generally less absorbent, but can often be prevented by changing the nappy more frequently (or by using an absorbent liner inside the cloth nappy). Friction can also contribute; as can irritation from diarrhoea when a baby is unwell.
Some babies are more prone to nappy rash, including those with a history of eczema or cradle cap (napkin dermatitis).
Sometimes the rash can develop a secondary fungal infection (most commonly candida) or bacterial infection (usually staphylococcus from the skin).
What does nappy rash look like?
The skin usually appears red and inflamed and sometimes spotty. It tends to spare the skin folds. A baby might clearly find it uncomfortable to have the affected area wiped and may be generally unsettled. Candida infection causes a classical spotty rash and staphylococcal infection can cause blisters and pustules.
How to treat nappy rash?
The most important thing is to change a baby’s nappy frequently, and to use a good quality, highly absorbent nappy (consider swapping to disposable for the short term, if you have been using cloth nappies). Also consider using a larger nappy size if friction seems to be contributing.
Allow nappy - free time for your baby as much as possible; this will encourage healing
Avoid baby wipes - even the unscented type can be extremely irritating to skin that is already inflamed. Instead, use cotton wool/ tissue/ fabric washers with warm water or sorbelene. Also avoid using talcum powder or any antiseptic creams/ products.
Apply a thick barrier cream with each nappy change. Zinc based creams tend to be effective but consider changing brand if you find that the cream you are using wipes off easily. I personally found Covitol brand to work well when my kids were in nappies - not sponsored; just sharing my experiences as a Mum! As a word of warning, Covitol also contains cod liver oil so smells a bit fishy.
If you are concerned about a secondary infection then see a GP, who can do a swab to test for infection and prescribe anti fungal/ antibiotic cream if appropriate. It is also important to see a GP if symptoms do not resolve with the above treatment - occasionally steroid creams are needed, and sometimes other more unusual causes of nappy rash need to be considered.
These two resources are useful summaries that I commonly share with patients:
