Nappy Rash

Nappy rash occurs when moisture from urine and faeces irritates the skin, or when the nappy chafes the skin. This skin condition is very common in children under two years old. In some cases the rash can also spread up the child’s back or onto their tummy. Nappy rash causes red, raw and itchy skin in the nappy area.¹

Overview

Nappy rash, or diaper rash, can be mild or more severe and is caused by chafing, infrequently changed or wet nappies, and skin sensitivity. It appears as patches of inflamed skin on the bottom, thighs and genitals. Frequent air-drying, using nappy rash cream, and changing the nappy frequently can clear up nappy rash. Anyone who wears a nappy can develop the skin condition, but it usually affects babies.²

CAUSES AND RISK FACTORS:

Nappy rash is a type of skin irritation with different causes. These include:

Infrequently changing dirty nappies. Wet or soiled nappies can irritate a baby’s sensitive skin if the nappy isn’t changed often enough.
When nappies are too tight and rub against the skin too much it may cause nappy rash.
New foods. Introducing the baby to new, solid foods can cause changes in the content and frequency of stools, which makes it more likely to develop nappy rash. It can also be due to antibiotics ingested through breastmilk.
New products. Babies have very tender skin which can be sensitive to new diapers, baby wipes or products used to clean and soften cloth nappies. The nappy rash can worsen as a reaction to ingredients in oils, lotions, powders or nappy rash creams.

Other potential risk factors to consider:

Skin sensitivities. Babies generally have very sensitive skin, but those with certain skin conditions are more likely to develop nappy rash. High-risk conditions include eczema or seborrheic dermatitis.
Bacterial or fungal (yeast) infections often develop quickly in the nappy area as it is moist and warm, and these can easily spread to other areas.
Important “good” bacteria that help keep yeast infections at bay are often killed when the baby has to take antibiotics or when breasted babies ingest antibiotics through their mothers’ milk. Antibiotics can also increase the risk of diarrhoea, therefore the risk of nappy rash as well.²

SIGNS AND SYMPTOMS

The symptoms of nappy rash all appear on the skin – but if your baby shows an increase in discomfort during nappy-changing time, it could be a sign that they have nappy rash.³

Physical symptoms of nappy rash include:

Nappy rash is a rash on the skin in and around the nappy area (genitals, buttocks, thighs)
The rash causes scaly, red skin ^3a
The whole area can be red, or it can have red patches.
In more severe cases, there are pimples, spots or blisters on the skin.
The skin can feel hot and look sore.⁴

DIAGNOSIS

Nappy rash may clear up on its own or is easily treated by applying nappy rash creams. Most cases aren’t very serious. However, in some cases require consulting a doctor. See a doctor if:

Nappy rash is accompanied with fever
The nappy rash doesn’t clear up in one week
The baby has blisters, pimples or crusts where the nappy rash is
If the nappy rash spreads
For boys, if the tip of the penis has a scab or is swollen and red
If your baby is extremely upset
If the rash bleeds, oozes or itches
If the rash causes urination or bowel movements to be painful and cause burning.^1,2

IMPACT ON QUALITY OF LIFE

While nappy rash can easily be treated at home with nappy rash cream, and in general does not pose a great risk, it can still take several days to heal. Nappy rash can be painful and cause your baby discomfort. If a nappy rash persists, it means that you will have to see a doctor and possibly be prescribed medication or nappy rash cream. In some cases, nappy rash can persist even when prescription medication or nappy rash cream has been applied, in which case you would have to take your baby to a dermatologist.²

TREATMENT

It’s easy to treat nappy rash by yourself at home. The frequency and manner of nappy changing plays a vital role in the treatment (and prevention) of nappy rash. If you follow the advice below, nappy rash will usually clear up within three days:

Frequently change the baby’s nappy – as soon as the nappy is wet or dirty.
Make sure to wipe from front to back and ensure the whole nappy area is cleaned.
Use fragrance- or alcohol-free baby wipes or water to thoroughly and gently clean the nappy area.
Your baby should be bathed daily, but avoid drying out their skin by bathing them more than once a day.
Don’t use lotions, soaps or bubble-bath
Don’t vigorously rub your baby when drying them; be as gentle as possible.
Once your baby is dry, let them lie on a towel without the nappy on as often and long as possible. This allows the skin to get fresh air.
Don’t use talcum powder on your baby’s skin as it can be an irritant.
Ensure the nappy fits the baby properly. Loose nappies can’t properly soak up urine, and overly tight nappies can cause skin irritations.
If the rash isn’t causing your baby to be upset, a thin layer of barrier cream should be applied to protect their skin.⁴

PREVENTION AND LIFESTYLE CHANGES

To prevent nappy rash, ensure that you do the following:

Frequently change the nappy to ensure the nappy area stays clean and dry.
Allow the baby’s bottom to be exposed to air as often as possible.
Apply protective barrier creams, which include creams containing zinc, petroleum jelly or castor oil. These creams will keep your baby’s skin in good condition.⁶
Avoid feeding your baby food that causes diarrhoea, as this will lead to more frequent nappy changes.
Use sprays such as Avène Thermal Spring Water, which can reduce the skin’s reactivity while boosting the skin’s defences and strengthening the skin barrier⁵.