What is a nappy rash?

Nappy rash is a common skin rash in babies who wear nappies. Most babies will get nappy rash at some time while they are in nappies, but there are some simple things you can do to help prevent problems.

Causes

Nappy rash is caused by irritation of the skin in the nappy area, usually around the buttocks and groin, as a result of prolonged exposure to urine and stools contained by nappies. 

There are a number of other factors that can contribute to the irritation of the baby's skin:

  • Rubbing of the skin by the nappy;
  • Chemicals in urine such as ammonia;
  • Traces of detergent in the material of cloth nappies;
  • Infection, and;
  • Some skin conditions, such as eczema and contact dermatitis.

Risk factors

Almost all babies have some signs of nappy rash at some point. Babies can be more prone to develop nappy rash when they:

Some aspects of care can also increase the risk of nappy rash.  These include:

  • Nappies not being changed frequently enough;
  • Plastic pants being put over the baby's nappy, and;
  • The baby being washed with fragrant lotions and soaps that can cause allergic reactions.

Signs and symptoms

The symptoms of nappy rash include:

  • Red, inflamed skin in the area of skin covered by the nappy;
  • Blisters, and;
  • Ulcers, which can occur when blisters burst.

The rash may spread to areas beyond those covered by the nappy.

Babies may be unsettled due to the discomfort of the rash, particularly when skin is wiped or comes into contact with urine. Older babies may scratch at skin in the affected area.

Baby with nappy rash.A nappy rash causes red and inflamed skin. 

Methods for diagnosis

A simple examination by a doctor is usually enough to diagnose nappy rash. If the doctor suspects that another infection or health condition is causing the rash, they may recommend other tests from a skin swab.

Swab

A small piece of absorbent material on a stick or in a clamp used for collecting a specimen, applying a medication, or cleaning or drying a surface of the body.

Types of treatment

Most cases of nappy rash can be cared for at home. There are simple things you can do to help your baby to get better:

Using nappies

To minimise irritation of the skin:

  • Choose a disposable nappy with good absorbency, as this helps to minimise contact of the urine with skin;
  • Change the nappy often, preferably as soon as you notice they are wet. For infants this may be around 5-7 times a day, and;
  • Avoid fastening the nappy too tightly.

If you choose to use cloth nappies:

  • Drying nappies in a tumble dryer can help make them softer to reduce skin irritation;
  • Using soft nappy liners may help to protect skin;
  • Avoiding plastic pants can reduce the amount of moisture held against the skin, and;
  • When hand-washing nappies, rinsing them thoroughly can help to remove all traces of detergent.

Cleaning baby's skin

Keeping skin clean of stools and urine can help to reduce irritation, but it is important to remember that over-cleaning of the skin can also cause irritation. To help minimise this, you can:

  • Avoid or minimise use of soaps and cleansers, including baby wipes, that can have irritating ingredients, such as alcohol;
  • Use a soft cloth or cotton wool rinsed in warm water to clean skin, and;
  • Gently wash and pat dry, rather than rubbing the skin.

Applying barrier creams

Another way to help protect the skin is to apply barrier creams, such as zinc cream or soft white paraffin. Only apply barrier cream to areas where there are no breaks in the skin. 

Avoid talcum powder as it can irritate the skin. As this is a fine powder, there is also a risk of it being inhaled by your baby.

If the nappy rash is severe, it does not improve within one week or spreads beyond the nappy area, your baby may need review by a doctor.

Medications

Medicated creams may be used in more severe cases of nappy rash. Creams containing a weak anti-inflammatory medication, such as hydrocortisone 1%, can help to reduce inflammation in the skin. All medicated creams containing cortisone must be used with medical advice, as prolonged or inappropriate use can lead to ulcers in the skin.

Potential complications

Nappy rash may develop into a skin infection. The usual signs are worsening redness, blisters, and possibly pus. Also, new areas of affected skin may develop beyond the main rash. This is particularly common with fungal infections, commonly known as thrush. If the nappy rash becomes infected, antifungal and/or antibacterial medication may be needed. Your doctor can advise if these are necessary.

Pus

A bodily fluid that is the result of an inflammatory response at an infection site. Its colour can range from whitish to yellow to green, depending on the composition. Pus is mainly composed of dead bacteria, white blood cells and cellular debris.

Thrush

Also known as candidiasis. An infection caused by the fungus Candida albicans. It can affect the tissues of the mouth or the vagina.

Prognosis

Most cases of nappy rash get better within a week. However, repeat episodes of nappy rash can occur. It is important to consider ways to prevent them. 

Prevention

To reduce the risk of your baby developing nappy rash: 

  • Use disposable nappies as they are more absorbent than cloth nappies, therefore the skin is kept comparably drier;
  • If you prefer cloth nappies, it is best to dry them in a tumble dryer as it can help make them softer. If hand-washing nappies, rinse them thoroughly to help remove all traces of detergent.
  • Use soft nappy liners to help protect the skin;
  • Avoid plastic pants as they reduce the airflow and absorption of moisture from the skin;
  • Frequent nappy changes are important - 5-7 times per day - to reduce the time that the skin is in contact with irritating urine and stools. Also, allow periods of time where your baby does not wear nappies;
  • Wipe baby's bottom with each nappy change with cotton wool or a clean cloth dampened with lukewarm water. Avoid or minimise use of soaps and cleansers, including baby wipes, that can have irritating ingredients, such as alcohol. Avoid talcum powder as it can also irritate the skin, and;
  • Apply a barrier cream with each nappy change to protect the skin. Seek help from your pharmacist or doctor if you are unsure what to use.