Nappy rash (Nappy dermatitis)
Introduction
Managing and protecting your newborn’s delicate skin is an essential aspect of their daily care. One of parents’ biggest concerns relates to the prevention and management of ‘nappy rash’.
What is nappy rash?
Nappy rash (nappy dermatitis) describes a number of inflammatory skin reactions that cause soreness and redness in the nappy area. In the majority of cases, it is a mild condition which affects around half of all nappy-wearing babies at some point. It is especially common in babies between the ages of nine to 12 months of age.
Causes
The condition is caused by prolonged contact with urine and faeces (‘poo’), or because of moisture or friction from the baby’s nappy. In the very early days post birth, nappy rash is most likely to develop around the baby’s anus (back passage) due to frequent contact with runny faeces, rather than urine. However, after the first month, nappy rash is more commonly associated with prolonged exposure to urine. Urine is ‘acidic’ so it can be extremely irritating to a baby’s sensitive skin. There also appear to be times when babies are more prone to developing nappy rash. This is particularly the case when the method of baby feeding changes from breastfeeding to infant formula milk (bottle) feeding; when your baby is teething, or has a tummy bug that gives them diarrhoea. Some babies also have more sensitive skin or, more rarely, are allergic to certain brands of nappy or baby skincare products (eg baby wipes or cleansing lotions) which can also cause nappy rash (ie allergic dermatitits). However, if your baby is allergic to anything it will become pretty evident soon after you’ve switched to that product!
What does it look like?
Nappy rash is likely to cause the skin in the nappy area to become red and inflamed. Your baby’s skin can look dry or moist and sometimes appears shiny with a pimply rash. In severe cases, tiny areas can peel away leaving behind raw areas of skin (this is called excoriation). Usually nappy rash will not bother your baby very much at all. However, in severe cases babies can become more distressed during nappy changes because it’s very sore for them.
Treatment
Prevention of nappy rash is the ultimate goal; however, where it does develop, treatment should reverse any skin damage and stop any reoccurrence. You can treat your baby’s nappy rash at home and it should take around three to four days to resolve.
Ensuring that your baby’s skin isn’t in prolonged contact with urine or faeces wherever possible is important, so regular nappy changes are essential. Try to change the nappy as soon as your baby has filled it. Nappies have undergone a significant number of improvements since the very first disposables appeared on the market. There are now a wide range of brands available which have highly absorbent cores that seal in the urine. However, even the most absorbent nappies will leave some moisture against your baby’s skin. ‘Reusable’ (real) cotton nappies are enjoying a huge surge in popularity with enhanced features that give ‘disposables’ a ‘run for their money’. There is actually no strong evidence to suggest that disposables are better than reusable nappies in preventing or treating nappy rash. See also our article ‘Reusable versus disposable nappies’.
Gentle cleansing whenever your baby wets or soils (dirties) their nappy using warm water and cotton wool is recommended. See also our article ‘Looking after your baby’. Don’t forget to pay particular attention to your baby’s skin-folds; if you have a baby boy be sure to clean underneath their testicles to ensure that no residual urine or faeces are left in contact with their skin.
Exposing your baby’s nappy area to the air in a warm environment can also help to promote healing. You can do this by placing your baby on a thick towel; if they are older and walking, you could also move their play area to a room with wipe-clean flooring. During warm weather, a garden or outdoor kiddies’ play area provides a great place for your baby to run around nappy-free!
Applying a thin layer of barrier cream at each nappy change can also help to promote healing. This should be rubbed in gently so that you can still see your baby’s skin rather than being applied as enthusiastically as ‘frosted cake icing’! Barrier creams and nappy ointments work by mimicking the skins natural function in forming a long-lasting barrier that helps to retain moisture. They also provide a barrier between your baby’s skin and their urine and faeces. However, you should always check the ingredients carefully. Barrier creams should not contain any unnecessary or harmful ingredients such as, perfumes, preservatives, or antiseptics.
Can nappy rash become infected?
Nappy rash is not an infection. However, because it weakens the skin’s natural barrier, infection can sometimes develop. Candida albicans (Thrush) is a very common yeast (fungal) infection which typically affects moist areas and skin folds. It starts off as pin-head sized red spots that quickly spread and merge to form a solid red blotch. Thrush is, however, a minor infection which is easily treated with an anti-fungal ointment that you apply topically (ie directly onto the affected area).
Occasionally, nappy rash can develop into a bacterial infection (with small pus-filled spots); where this is the case your GP will prescribe antibiotics.
Sometimes it can be appropriate to treat the condition with a steroid ointment (Hydrocortisone). However, your GP would only consider this where other approaches have proved ineffective. If your baby’s nappy rash is not improving or you have any concerns, you should contact your midwife or health visitor for their advice.
