Family doctor

What is it?

Nappy rash (irritant dermatitis) is a very common condition in babies and toddlers. It refers to inflammation of the skin in the nappy area, usually sparing the groin creases.

Primary causes:

Prolonged contact between the skin and urine or faeces causes the irritation. Sometimes soaps and detergents not properly rinsed from the nappy may contribute. Diarrhoea, with frequent soiling of the nappy, often makes it worse.

Secondary infection:

Sometimes nappy rash may be infected with candida (thrush), and this is indicated by a whitish scaling at the edge of the rash, or small spots. A course of antibiotics may cause candida infection.

Occasionally there is a bacterial infection. There may be an intense red skin colour, peeling or spots.

Other causes

Allergic dermatitis is a skin rash which develops in reaction to contact with a particular substance. This may occur in the nappy area.

Intertrigo is redness in the groin creases due to the skin being too moist.

Seborrheic dermatitis presents as nappy rash involving the groin creases. There may be a rash elsewhere on the body, such as on the scalp.

Psoriasis is a condition causing a red scaly rash on any part of the body - it is rare in children.

Treatment

• Keep the area dry by changing the nappy frequently, especially after a bowel motion.
• Use disposable nappies which absorb moisture better than cloth nappies.
• Give the baby some time without a nappy on during the day if possible.
• Clean the skin with warm water and pat dry carefully.
• If using cloth nappies, rinse them thoroughly to remove any detergent.
• Use a barrier cream on the nappy area after every nappy change. Products available from a pharmacy include: zinc and castor oil ointment, petroleum jelly, vitamin A ointment, Karicare and Wellada barrier ointments.
• If there is candida (thrush) infection present there are some creams available from a pharmacist to use with a barrier cream. These may contain: clotrimoxazole, miconazole nitrate, nystatin, ketoconazole, or econazole nitrate. Some also contain 1% hydrocortisone, a mild steroid to use if the skin is very inflamed.

If the nappy rash is not getting better after a few days or if the child seems unwell, it is important to see a doctor. There may be a bacterial super infection that requires antibiotics, or the nappy rash may be due to one of the other causes listed above.