Nappy Rash
Introduction
Nappy rash or nappy dermatitis is a condition that leads to skin irritation, redness and soreness over the buttocks and surrounding area covered by a nappy or diaper.
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Baby with nappy rash or nappy dermatitis on buttocks
Who gets it?
Nappy rash is common in babies aged 3 to 15 months of age.
Infants wearing traditional cloth nappies are twice as likely to get nappy rash than babies wearing breathable disposable nappies.
Nappy rash can also affect older children and adults who are incontinent.
Babies with more sensitive skin or skin conditions like eczema or psoriasis are more likely to get nappy rash.
Nappy rash affects boys and girls equally.
What causes it?
Causes of nappy rash include:
Nappy rash is most often caused by prolonged contact with a wet or soiled nappy
Moisture as well as friction between the nappy and the baby’s skin can lead to breakdown of the skin’s protective barrier and cause irritation
Excessive use of soaps, cleaning agents and wipes can also dry out the skin leading to cracks to the skin
Substances in the urine and faeces can then penetrate the protective barrier leading to skin redness, irritation and pain
What does it look and feel like?
Looks like…
Red, inflamed or swollen skin over the buttocks and genitals of the baby
Skin may peel and leave raw areas
If severe, this can spread to the tummy and back of the infant
Sometimes the skin can get infected and, depending on the type of infection, skin can look different
Feels like…
Itch is common
There may be discomfort or pain with weeing and pooing once the skin is broken
If skin is infected your child may have worsening pain
What tests might be needed?
Usually tests are not needed to diagnose nappy rash. Sometimes bacterial, viral or fungal infections can occur at the same time as the nappy rash and your GP may do a skin swab to confirm this. This test is done with a cotton tip and is painless.
What treatments are available?
What can I do?
Preventing nappy rash
Change your baby’s nappy more frequently
Use disposable nappies that have better absorption to prevent moisture sitting against the baby’s skin
Minimise the use of strong soaps, cleaning agents and/or wipes when cleaning your infant’s bottom. Instead wash with water alone or wipe with wet cotton flannels or wash cloths
Use a barrier cream to protect your baby’s skin from soiled and wet nappies
Make sure you completely dry your baby’s bottom before putting on their nappy
Give your baby nappy-free periods regularly throughout the day - more frequent and short bursts are better than infrequent long periods.
Do not use talcum powder or antiseptics on nappy rash.
Medical therapies
Topical therapies
Steroid cream- your doctor may prescribe a steroid ointment to use once or twice-daily
Barrier cream - your doctor may suggest a particular barrier cream without preservatives, and potential allergens
Antifungal creams- if a thrush infection is suspected your doctor may suggest using a cream to treat this
Antibiotics- either as a cream or liquid by mouth may be required if there is a bacterial infection
What happens after treatment?
Your child's nappy rash will resolve after appropriate treatment and good skin management. If your child has sensitive skin, nappy rash tends to recur. Once they are out of nappies the rash will automatically settle.
If your child attends childcare then nappy rash is likely to keep recurring. In a group setting, carers find it difficult to stick to a meticulous skin care routine and to get soiled nappies changed in a timely manner. If your child is suffering from frequent nappy rash and is attending childcare, request a letter from your GP or dermatologist for the child care so that the carers can follow the nappy care advice and put on appropriate treatments.
What support is available?
Usually a simple nappy rash will resolve quickly with the simple measures without needing medicated treatments. If it persists for more than a few days it is best for your child to be reviewed by your local GP who may prescribe other treatments like an antifungal cream or antibiotic or refer your child to a dermatologist.
Authors/Reviewers:
Author: Dr Beverly Manago
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
