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Nappy rash

What is nappy rash?

It is a red, irritating skin rash corresponding to the area covered by the nappy. It affects the genitals, buttocks, groin and thighs, but usually spares the creases not in contact with the nappy.

What are the symptoms?

The skin is red, spotty and moist. It is irritated when urine is passed, and so causes the baby to cry.

What causes nappy rash?

It is basically caused by excessive contact of the skin with urine or faeces. It is common-most babies have nappy rash at some time, but the skin of some babies is more sensitive than others. The appearance of nappy rash does not mean that the carer/s have been neglectful.

The main cause is dampness due to urine and faeces, especially from a chemical formed from the urine in the nappy.

Other causes or aggravating factors are:

• a tendency of the baby to eczema
• a tendency of the baby to seborrhoea
• infection, especially monilia (thrush)
• rough-textured nappies
• detergents and other chemicals in the nappies
• plastic pants (aggravates wetness)
• excessive washing of the skin with soap
• too much powder over the nappy area
  

What is the treatment?

1. Keep the area dry. Change wet or soiled nappies frequently and as soon as you notice them.
2. After changing, gently remove any urine or moisture with diluted sorbolene cream or warm water.
3. Wash gently with warm water, pat dry (do not rub) and then apply any prescribed cream or ointment to help heal and protect the area. Lanoline or zinc cream applied lightly will do.
4. Expose the bare skin to fresh air whenever possible. Leave the nappy off several times a day, especially if the rash is severe.
5. Do not wash in soap or bath too often-once or twice a week is enough.
6. Avoid powder and plastic pants.
7. Use special soft nappy liners that help protect the sensitive skin.

How to care for nappies

1. Rinse soiled nappies immediately in cold water and rinse out any disinfectants or bleaches used before washing.
2. Wash the nappies in a normal hot wash in the washing machine.
3. Make sure the nappies are rinsed to remove chemicals used and then dried.

Key points

• Keep the skin dry.
• Expose the skin to air and sunlight where possible.
• Use protective creams.
• Do not use soap or plastic covers.
• Do not bath the baby too much.
• Visit your doctor if the rash is not responding after 4 days.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia