Dr Claudine De Munter | Paediatrician | The Portland Hospital
Nappy rash is a common condition affecting up to a third of nappy-wearing babies. It is caused by a baby's delicate skin coming into contact with irritating chemicals in urine and stools. The baby’s skin becomes sore and irritated in the area around the nappy, covered in pink, red spots or blotches. Most nappy rashes are mild and can be treated with a simple skin care routine. Some nappy rashes are more severe and can be complicated by an associated fungal or bacterial infection. Severe rashes are painful and require do require treatment.
For mild rashes it is best to leave the nappy off whenever possible and to change the nappies regularly especially as soon as it is wet or soiled. Highly absorbent nappies are more efficient. Avoiding the use of soaps and only using water to clean the nappy area helps avoid dry easily irritated skin. The skin should be completely dried with a soft material. A barrier cream is useful every time the nappy is changed such as zinc cream, zinc oxide ointment, petroleum jelly are all suitable creams. Talcum powder must not be used because it does not protect and can cause friction and irritate the skin further.
Severe nappy rash needs medication. It presents as bright red spots, dry, cracked, broken skin, swellings, ulcers or blisters over a larger part of the nappy area and may spread down the legs or up to the abdomen. The baby may cry and be irritable. Topical corticosteroids reduce inflammation of the skin: Hydrocortisone cream is applied to the baby's skin once a day and not for more than seven days in a row. Topical antifungals are often applied simultaneously because candidal infections are often associated. These creams are applied to the nappy area two to three times a day and for 7 days after the rash has healed. The skin may become infected by a bacteria and this may be associated with fever. The skin can then present with blisters and collections of pus and is painful. These babies need to be treated with a course of antibiotics.
Other causes of rashes, in rare cases, the nappy rash may be caused by an underlying condition such as eczema, seborrhoeic dermatitis or allergic dermatitis. If you have any concerns please discuss these with your GP or paediatrician.
Dr Claudine De Munter Paediatrician at The Portland Hospital can be contacted on 020 7390 8295.