Causes and treatment of nappy rash

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Nappy rash is a common form of inflamed skin (dermatitis) that appears as a patchwork of bright red skin on your baby’s bottom. It is often related to wet or infrequently changed diapers, skin sensitivity, and chafing.

It usually affects babies, though anyone who wears a diaper regularly can develop the condition. It usually clears up with simple at-home treatments, such as air drying, more frequent nappy changes and ointment. If your baby’s skin doesn’t improve after a few days of home treatment, talk to your doctor.

Sometimes, you’ll need prescription medication to treat the rash. As a parent you can worry if the rash is severe or unusual, gets worse despite home treatment, bleeds, itches or oozes or causes burning or pain with urination or a bowel movement and is accompanied by a fever.

In the time leading up to your appointment, avoid products that seem to trigger your baby’s rash. Wash your baby’s bottom with water after each nappy change. Avoid soaps and wipes containing alcohol or fragrance.

Try and give your baby as much nappy-free time as possible, so his or her skin has a chance to stay dry and start healing.

When you do use nappies, change them frequently and apply a nappy rash cream, lotion, paste or ointment to act as a barrier between your baby’s skin and a dirty nappy.

In the past, it was common to use talcum powder to protect a baby’s skin and absorb excess moisture. Doctors no longer recommend this as inhaled powder can irritate a baby’s lungs.

CAUSES

• Irritation from stool and urine Prolonged exposure to urine or stool can irritate a baby’s sensitive skin. Your baby may be more prone to nappy rash if he or she is experiencing frequent bowel movements or diarrhoea because faeces are more irritating than urine.
• Chafing or rubbing Tight-fitting nappies or clothing that rubs against the skin can lead to a rash.
• Irritation from a new product Your baby’s skin may react to baby wipes, a new brand of disposable nappies, or a detergent, bleach or fabric softener used to wash cloth nappies. Other substances that can add to the problem include ingredients found in some baby lotions, powders and oils.
• Bacterial or yeast (fungal) infection What begins as a simple skin infection may spread to the surrounding region. The area covered by a nappy is warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can be found within the creases of the skin, and there may be red dots around the creases.
• Introduction of new foods As babies start to eat solid foods, the content of their stool changes. This increases the likelihood of nappy rash. Changes in your baby’s diet can also increase the frequency of stools, which can lead to nappy rash. If your baby is breast-fed, he or she may develop nappy rash in response to something the mother has eaten.
• Sensitive skin Babies with skin conditions, such as atopic dermatitis or seborrheic dermatitis (eczema), may be more likely to develop nappy rash.
• Use of antibiotics Antibiotics kill bacteria so when a baby is on them, bacteria that keep yeast growth in check may be depleted, resulting in nappy rash due to yeast infection. Antibiotic use also increases the risk of diarrhoea. Breast-fed babies whose mothers take antibiotics are also at increased risk of diaper rash.

SYMPTOMS

• Skin signs: Nappy rash is marked by red, tender-looking skin in the buttocks, thighs and genitals.
• Child irritability: You may notice your baby seems more uncomfortable than usual, especially during nappy changes. The child might cry when the nappy area is washed or touched.

TREATMENT

The best treatment for nappy rash is to keep your baby’s skin as clean and dry as possible. However, if the rash persists, the following might be helpful:

• A mild hydrocortisone (steroid) cream
• An antifungal cream, if your baby has a fungal infection
• Topical or oral antibiotics, if your baby has a bacterial infection

PREVENTION AND HOME REMEDIES

• Keeping nappy area clean and dry The best way to keep your baby’s nappy area clean and dry is by changing nappies immediately after they are wet or soiled. After you’ve cleaned and dried the skin, apply a cream, paste or ointment. Certain products, such as zinc oxide and petroleum jelly, work well to protect the skin from moisture.
• Increasing airflow To aid the healing of nappy rash, do what you can to increase air exposure to the nappy region. These tips may help: air out your baby’s skin by letting him or her go without a nappy and ointment for short periods of time, perhaps three times a day for 10 minutes each time, such as during naps; Avoid airtight plastic pants and nappy covers; use nappies that are larger than usual until the rash goes away.
• Zinc oxide is the active ingredient in many nappy rash products They are usually applied to the rash throughout the day to soothe and protect your baby’s skin. It doesn’t take much – a thin covering will do. The product can be applied over medicated creams, such as an antifungal or a steroid, when necessary. You could also apply petroleum jelly on top, which helps keep the nappy from sticking to the cream.
• As a general rule, stick with products designed for babies Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine, or salicylates. These ingredients can be toxic for babies.
• Bathing daily Until the rash clears up, give your baby a bath each day in warm water with mild, fragrance-free soap.
• Rinse your baby’s bottom with warm water as part of each nappy change You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin, but be gentle. Don’t use wipes with alcohol or fragrance. If you wish to use soap, select a mild, fragrance-free type.
• Gently pat the skin dry with a clean towel or let it air dry Don’t scrub your baby’s bottom. Scrubbing can irritate the skin.
• After changing nappies, wash your hands well Hand-washing can prevent the spread of bacteria or yeast to other parts of your baby’s body.

Dr Dulcy Rakumakoe. Picture: Refilwe Modise