Introduction
Nappy rash is a skin irritation that occurs in the nappy area, caused by prolonged exposure of the skin to urine and faecal matter. It will occur to most babies at some stage, no matter how well cared-for. Some conditions such as psoriasis, atopic dermatitis (eczema) or diarrhoea can also make nappy rash worse.
Children will eventually grow out of it when they do not require diapers anymore.
Signs & Symptoms
Symptoms can include:
- Red and inflamed skin around the genital area and anus that sometimes spread to stomach and thigh region
- Dry and cracked skin
- Blisters and ulcers
- Itchy and painful skin can cause baby to be unsettled and have difficulty in sleeping
When To Seek Medication Attention
Most cases of nappy rash can be treated successfully at home. However, in some cases, germs colonise the irritated skin, leading to complications. See your doctor if your baby’s nappy rash does not get better in a week or is getting worse, pus-filled blisters or crusts appear, and if the child cries intensely after passing stools, has difficulty sleeping or an unexplained fever.
Causes
Nappy rash is caused by skin irritation due to prolonged contact with a dirty diaper, when bile salts, enzymes and ammonia break down the skin layer; this can be made worse by chafing from the diaper. Sometimes, the injury to the skin can make the baby more vulnerable to secondary infection caused by fungus and bacteria.
Lifestyle interventions
The following might be helpful for nappy rash:
Change your baby more frequently during the duration of the nappy rash to keep the skin clean and dry.
Having a “nappy-free” time each day for as long as possible to air your baby’s bottom.
Ensure clothing and nappies are not too tight.
Avoid using plastic pants as they do not promote good circulation.
If you are not using disposable nappies, ensure all washed nappies are rinsed thoroughly to remove traces of detergents and other chemicals.
Use cotton wool and water or alcohol and fragrance-free baby wipes to clean your baby’s bottom. Clean girls from the front to back, and remember to clean boys thoroughly around the genital area.
Use a barrier cream or ointment on dry skin after each nappy change. This will help to protect your baby’s skin from the urine and faeces. However, if a baby’s nappy rash is caused by thrush, do not use a barrier cream as this might worsen the problem.
Treatment Options
A low potency steroid such as hydrocortisone cream is available from a pharmacist and can be used to bring down swelling and alleviate itching. Do not use for more than a week, and only if you are sure there is no fungus or bacterial invasion.
For diaper rash with fungal involvement, an antifungal cream such as miconazole can help. A combination cream of antifungal and hydrocortisone is also available. Please see a doctor for diagnosis if you are unsure.
If you suspect a bacterial infection, which is characterised by pus, crusty rash or warm and swollen skin, see your doctor for possible antibiotic treatment.
