Nappy rash

Page last reviewed: 13/07/2011

Nappy rash is a common condition thought to affect up to a third of nappy-wearing babies at any given time.

It causes your baby's skin to become sore and irritated in the area around the nappy, and covered in pink or red spots or blotches.

Nappy rash is usually caused by your baby's skin coming into contact with urine and faeces in their nappy.

The rash usually develops when your baby is between 9 and 12 months old.

How serious is it?

Most nappy rashes are mild and can be treated with a simple skin care routine. Your baby will usually feel no pain or discomfort.

However, some nappy rashes are more severe and can be caused by an underlying condition or bacterial infection. A severe rash is painful and distressing for your baby. It usually requires treatment with medication (see Treatment of nappy rash for more information).

Page last reviewed: 13/07/2011

The symptoms of nappy rash vary depending on how severe your baby's rash is. Most cases of nappy rash only produce mild symptoms.

Mild nappy rash

If your child has mild nappy rash, a small part of their nappy area will be covered in a pink or red rash, usually made up of small spots or blotches. However, they should feel well and will only experience a stinging sensation when passing urine or faeces.

Severe nappy rash

If your baby's nappy rash is severe, they may have more advanced and painful symptoms that make them distressed or uncomfortable. Symptoms may include:

  • bright red spots
  • dry, cracked and broken skin
  • swellings, ulcers and blisters on the skin

The rash will cover a larger part of the nappy area and may spread down the legs or up to the abdomen (tummy). Your baby may cry more often than usual and be irritable.

Contact your GP immediately if your child develops severely inflamed (swollen and irritated) skin or a fever. This may be a sign of infection.

Page last reviewed: 13/07/2011

Nappy rash usually occurs when your baby's skin comes into contact with urine and faeces.

Ammonia

When a baby soils or wets itself, the nappy cannot always absorb the waste products. This means that your child's delicate skin will come into contact with urine and faeces. When a nappy is left on for a long time, the urine and faeces can turn into the chemical ammonia. Ammonia can irritate your baby's skin, causing it to become sore and inflamed.

Fungal infection

Nappy rash can also be caused by a fungal infection. If your baby's skin is warm and damp for long periods of time, it can cause a fungus, known as candida, to grow. Like ammonia, candida can irritate your baby's skin. Sometimes, your baby's rash starts as a reaction to the ammonia, then is further complicated by a fungal infection.

Underlying conditions

In rare cases, your baby's nappy rash may be caused by an underlying condition. Some of these conditions are listed below.

Eczema

Eczema makes your baby's skin dry and sore. The sore skin may appear in other parts of the body beyond the nappy area. If your baby often has nappy rash despite regular nappy changes, and you have a family history of eczema, the nappy rash may be the first signs of eczema. For more information, see Health A-Z: atopic eczema

Seborrhoeic dermatitis

Seborrhoeic dermatitis causes red, scaly skin. It usually occurs when your baby is between two weeks and six months old. You may also notice reddened skin on your baby's scalp, ears, eyebrows, armpit and neck. Normally, seborrhoeic dermatitis lasts for a few weeks, and does not reoccur or disturb your baby.

Bacterial infection

Sometimes, your baby's nappy area can become infected with bacteria. This can cause a bright red, painful rash that will need to be treated with antibiotics.

Allergic dermatitis

Sometimes, your baby's rash may be caused by an allergic reaction to a particular substance (allergen). An allergen causes the body's immune system to react abnormally, leading to irritation and inflammation in the affected body part.

Many different types of allergen can cause your baby to have an allergic reaction, including:

  • soap
  • fragrances
  • preservatives
  • detergents
  • oils
  • powders

Sometimes, it is obvious which allergen is causing your baby's allergic dermatitis. For example, the rash may have developed after you used a new type of soap on their skin.

But in some cases, it may be harder to identify the exact cause of their reaction. If your GP cannot identify the allergen, they may refer your baby for allergy testing. This will involve testing your baby with very small amounts of various substances, to see if any of them trigger a reaction.

If your baby's nappy rash is caused by allergic dermatitis, treat the rash the same way that you would treat a mild nappy rash (see Treatment - nappy rash). If your baby has symptoms of a severe nappy rash after an allergic reaction, contact your GP.

If you know which allergen is causing your baby's nappy rash, make sure that they do not come into contact with it. This will help to prevent further allergic reactions.

For more information, see Health A-Z: contact dermatitis

Psoriasis

Psoriasis is a very rare condition in babies, but when it occurs, it normally affects the nappy area. Psoriasis causes a rash with red scales that has a defined border. This condition most commonly starts when your child is around two months old. It usually lasts two to four months. For more information, see Health A-Z: psoriasis

Zinc deficiency

Zinc deficiency is more common in premature babies. It causes a rash, which appears around the nappy area, and around the mouth and hands.

Page last reviewed: 13/07/2011

Nappy rash is a very common condition. However, most rashes are mild and can be safely treated at home, without having to visit your GP.

Contact your GP if your baby's rash gets progressively worse, becomes infected or is causing significant discomfort. Your GP can usually diagnose your baby's rash by its appearance.

They may also carry out a physical examination to check whether your baby has a rash on any other part of their body, which may indicate that the rash is caused by an underlying condition or is a symptom of another problem, such as a bacterial infection.

Referral

If your baby has a nappy rash that remains severe and distressing despite treatment, they may be referred to a dermatologist (a doctor who specialises in skin conditions). The dermatologist can further investigate your baby's rash to identify the cause.

Your child may also be referred to a dermatologist if they have nappy rash frequently.

Page last reviewed: 13/07/2011

Mild nappy rash

If your baby has a mild nappy rash, they will not normally need any medication or specialist treatment. Instead, there are steps you can take to safely treat the rash at home.

Leave your baby's nappy off as long as possible

Not putting a nappy on your baby will help them to stay dry and avoid contact with faeces or urine. It is usually most convenient to leave your baby's nappy off when they are asleep. You can lay them on an absorbent towel or somewhere where you can easily manage any soiling or wetting.

Avoid using soaps when cleaning your baby's skin

Only use water to clean your baby's nappy area in between changes. Use a soft material, such as cotton wool or a soft towel, when drying. Dab the affected area carefully and avoid rubbing their skin vigorously.

Avoid bathing your baby more than twice a day. Experts think this may dry out their skin and cause a more severe nappy rash.

Apply a barrier cream every time you change their nappy

Using a barrier cream or ointment after each nappy change will reduce the contact that your baby's skin has with urine and faeces. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams. Ask your pharmacist for advice about which cream is most suitable for your baby.

Change your baby's nappy frequently

To lower the risk of your baby getting nappy rash, change your baby's nappy as soon as they wet or soil it. If your baby has nappy rash, make sure you change their nappy more frequently than you normally would.

Consider changing the type of nappy you are using

If you are using disposable nappies, use one that is highly absorbent. However, these are often more expensive than other nappies. If you cannot use high-absorbency nappies, make sure you change the nappy frequently; ideally, as soon as your baby wets or soils it.

Severe nappy rash

If your baby has severe nappy rash, they usually need medication to treat the condition. Your GP will first check that you have been carrying out the skin care routines advised for a mild nappy rash (see above).

Once your GP is satisfied that the correct skin care routines are being followed, they usually prescribe some topical medicines to treat the rash. 'Topical' means that the medicine is applied directly to the affected area (in this case, the nappy area).

Topical corticosteroids

Corticosteroids help to reduce inflammation of the skin and relieve any itching and redness. Hydrocortisone cream is often prescribed. You have to apply it to your baby's skin once a day. You can stop using hydrocortisone as soon as the rash has cleared, but do not use it for more than seven days in a row.

Topical anticandidals

An anticandidal medicine helps to treat any fungal infection that may be causing your baby's rash. Some commonly prescribed anticandidal medicines include:

  • clotrimazole
  • econazole
  • ketoconazole
  • miconazole
  • sulconazole
  • nystatin

These are creams that usually have to be applied to your baby's nappy area two to three times a day. However, unlike topical corticosteroids (which you stop using once your baby's rash has cleared up), anticandidals have to be used for 7 to 10 days after the rash has healed. This ensures that the infection is completely treated.

Page last reviewed: 13/07/2011

Most cases of nappy rash are easily treated and do not cause complications for your baby.

Bacterial infection

In some rare cases, a nappy rash can become infected with bacteria. This can make your baby's skin significantly more painful and can be distressing for them.

Symptoms of a bacterial infection can include:

  • irritated, reddened skin
  • collections of pus (which may ooze)
  • lesions (areas of damaged tissue)

A bacterial infection usually requires treatment with antibiotics, so it is important to contact your GP if your baby displays the above symptoms.

Page last reviewed: 13/07/2011

The best way to prevent nappy rash is to follow good skin care routines. You can do this by following the same guidelines for treating a case of mild nappy rash. This means:

  • leaving the nappy off as much as possible
  • changing the nappy regularly
  • using only water to wash your baby's bottom
  • applying a barrier cream after each nappy change

Other ways you can help to prevent a rash include:

  • drying your baby's bottom by patting (not rubbing) it with a towel
  • not using tight-fitting plastic pants over nappies
  • not using powders (such as talcum powder) when changing nappies

Do not use talcum powder when changing your baby's nappy because, unlike a barrier cream, it does not protect your baby against urine and faeces. It can also cause friction and irritate your baby's skin.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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