Treating Nappy Rash

Nappy rash (irritant dermatitis) can make babies and toddlers quite miserable, unsettled and irritated and you would too if your nether regions were feeling constantly sore and itchy! Nappy rash is a very common childhood ailment, affecting the skin of the nappy area. Fortunately, there are lots of ways to prevent nappy rash, and lots of options to treat it.

What Causes Nappy Rash?

• The closed environment of a nappy.
• Friction, rubbing.
• Contact with wee and poo – bile salts and enzymes present in baby poo can break down the lipid and protein barrier of the skin. Bouts of diarrhoea with the frequent soiling of nappies can make this worse.
• Bacteria.
• Chemical irritation/sensitivity – sometimes the soaps or detergents used to wash cloth nappies can cause this if not rinsed properly.
• Teething – can sometimes worsen nappy rash. Thought to be because the baby is making more saliva and this causes changes to their poo.
• Children with pre-existing skin conditions like atopic dermatitis or seborrheic dermatitis can be more predisposed to nappy rash.
• As babies start to eat solid food, their stool frequency and pH increase which means nappy rash can happen more often.

What Are The Symptoms Of Nappy Rash?
Skin affected by nappy rash looks red, shiny, chafed and flaky. A rash can appear around the inner thighs, genitals, lower tummy, lower back, and buttocks.

Nappy rash does not usually appear in the groin creases. If the groin creases are affected, this may indicate there is a fungal infection (Candida/thrush). With Candida there are “satellite” lesions or little spots near the main red areas. The rash can be very red, with a whitish scaling at the rash edges. Candida is more common after a course of antibiotics.

If the skin has a bacterial infection it will look intensely red with peeling and spots.

Tips To Help Prevent Nappy Rash

• Use the right size nappy and not on too tight
• Have bare bottom time as much as possible
• Apply a thick coat of barrier cream/ointment at every nappy change – this prevents wee or poo coming into contact with the skin
• Change nappies often to decrease the chance of wet skin and contact time with faecal enzymes
• Wipe skin with warm water and a soft washcloth at each change
• If using wipes, make sure they are mild and unscented
• Keep skin as dry as possible
• Gently pat skin dry
• Use nappies with absorbent gel materials that draw moisture away from skin
• Use soap-free cleanser with moisturiser or a very mild soap (i.e pH neutral with no dyes, fragrances or preservatives).
• If using cloth nappies, use liners to keep skin dry.

Try These Treatments For Nappy Rash

Look for treatments that contain the following ingredients that soothe and heal nappy rash:

• Zinc oxide – aids repair, maintenance and protection of skin. It is soothing and anti-itch. It has anti-inflammatory and skin healing properties. Often present in barrier creams.
• Vitamin A ointment, zinc and castor oil, petroleum jelly (soft white paraffin) – all used as barrier creams.
• Miconazole, clotrimazole, nystatin – anti-fungals used to treat fungal Candida (thrush) infections. Apply before applying barrier cream, two to three times daily for 7 to 14 days after the infection has cleared. Wait a few minutes after applying before applying barrier. Available from a pharmacy.
• Hydrocortisone 0.5% to 1% – a mild steroid that is used sparingly once or twice daily for up to seven days if the skin is very inflamed. Will relieve redness and inflammation. Available from a pharmacy.

Other Tips To Avoid Nappy Rash
Avoid:

• Plastic overpants.
• Baby talcum powders. These do not protect the skin and can be quite abrasive. They can actually promote bacteria or Candida growth. If inhaled they can cause respiratory irritation.
• Soaps – these can strip lipids from the skin and cause it to dry out too much.
• Bubble baths.
• Disposable wipes – although convenient they can lead to contact allergy to preservatives which are added to stop wipes going mouldy.

Tips:

• Give evening fluids early to decrease wetting at night.
• Certain foods may increase stool acidity or frequency (e.g. orange juice) and be more likely to contribute to nappy rash for your child.

When To See A Doctor
If your child isn’t getting better after a few days or they seem very unwell it’s wise to see a doctor. It is important to check that the rash is not a bacterial infection that will require oral antibiotics.