Nappy rash is a common skin irritation that develops in the area beneath a baby's nappy. Nappy rash commonly happens when a baby’s skin is exposed to wet or dirty nappies for too long. Urine is normally sterile (in the absence of certain conditions or infections). However, germs on the baby’s skin and in the nappy can change chemicals in urine into other chemicals, such as ammonia. This is very irritating to skin. 


Some babies get nappy rash no matter how well they are cared for. Others do not get nappy rash, even when they are not changed very often. Some babies may have very sensitive skin and rashes on other parts of their bodies. Others may have infections, such as thrush, which make the rash worse. Some babies only get nappy rashes when they have a cold or some other viral illness. 




The symptoms of nappy rash include:


• Red and Inflamed skin – the skin around the genital area and anus looks red and moist.

• Blistering – the skin may blister and then peel, leaving raw patches (ulcers).

• Spreading – the rash can spread onto the tummy and buttocks.

• Ulcers – small ulcers can sometimes form on healthy skin near the area of the rash.

• Swelling


All of this damage to the skin is very sore and the baby can be very, especially when they pass urine that comes into contact with the rash. Many babies with nappy rash do not sleep well, waking often due to pain.


Different types of nappy rash have different symptoms:


Mild: Red (but not bright red) skin which does not reach the folds of the skin; baby only shows distress when they are wet or soil themselves; and symptoms disappear after a few days with treatment.


Fungal infection: Bright red skin that may appear in the folds of skin and on the bottom; and the baby cries when you change nappy. 


Serious infection (when to see the doctor): Rash is bright red, very warm and swollen;  fever; irritable baby; blisters, crusts or pimples appear; and the rash does not go away after a few days of treatment.




Various factors may combine to cause nappy rash. These include:


• Excess skin hydration from exposure to the water in urine and stools.

• Skin trauma from friction between nappy and baby's skin.

• Ammonia – chemicals in urine may be changed into ammonia, which ‘burns’ the skin.

• Thrush (candida) – thrush exists in faeces normally, but the levels rise sometimes without obvious causes. This can occur when a baby needs antibiotics for another infection. Thrush can make a nappy rash much redder and more painful.

• Chemical exposure – chemicals in nappy-soaking solutions, laundry detergents and fabric softeners can irritate the skin of very sensitive babies. Some baby wipes may cause irritation if they contain alcohol. Some scented soaps or baby lotions can also irritate the skin of some babies.

• Plastic pants – these may keep the baby’s clothes clean and dry, but they prevent airflow. Because the clothes do not get wet, a baby may be left in a wet or dirty nappy for a long time and this keeps the baby’s skin wet.

• Sensitive skin – babies who are prone to rashes such as cradle cap or eczema are more likely to get nappy rash.




Suggestions to treat or prevent nappy rash include:


• Change your baby’s nappy more frequently, even during the night.

• Use disposable nappies, which absorb the urine quickly and leave the surface of the nappy (that is next to the skin) dry.

• Use warm water and a mild soap to clean your baby rather than disposable wipes which often contain alcohol.  Alcohol stings badly on damaged skin.

• Use a barrier cream, such as Bepanthen Cream, Covitol Nappy Rash Cream, Herron Zinc and Castor Oil Cream, to keep wetness away from baby’s skin. Apply a thin layer of nappy rash cream after every change ensuring skin is dry beforehand.

• Make sure you change cloth nappies often and, whenever possible, do not put plastic pants over them.

• Rinse thoroughly all washed nappies to remove traces of detergents and other chemicals. Then, if possible, dry them in a tumble drier – this makes them much softer than drying them in the sun.

• Let the baby's bottom 'air' by removing the nappy when you can 

• Give pain relief if necessary. Rashes such as nappy rash are very painful, especially when urine gets onto them. If your baby is unsettled, try some paracetamol to ease the pain (check the bottle to see how much to give to your baby).


Most cases of nappy rash can be treated successfully at home. See your doctor if your baby’s nappy rash looks severe, is hurting your baby or doesn’t clear up within a few days. Medical treatment may include antifungal creams for thrush or steroid creams (such as hydrocortisone cream). When using these creams, wash the skin well, put a thin layer of the cream on, then (after a couple of minutes) cover the skin and the cream with a barrier cream, such as zinc and castor oil. Note: zinc creams leave stains on nappies and clothes. Many people use disposable nappies while treating nappy rash.