Nappy rash is a skin condition that causes babies’ skin to become red and sore on the buttocks and nearby areas.
It is usually caused by wet dirty nappies touching and rubbing the skin. The rash can worsen if the skin gets infected, or if it is even more irritated by urine, faeces, soap or detergent.
Nappy rash can be mild and clear up easily with home care, or it can be more severe and need medical treatment. Severe nappy rash is more widespread and there may be open, weepy sores.
What causes nappy rash?
The most common type of nappy rash is irritant dermatitis – a skin irritation that can happen when dirty, wet nappies are touching the baby’s sensitive skin. It is caused by a combination of wetness, the nappy rubbing against the skin, and skin damage caused by the enzymes in faeces. Urine and detergents can worsen the irritation.
Once the rash has started, it can become infected with bacteria that normally live on the skin, or with a fungus (Candida) that normally lives in the intestine and on the skin. Infections can easily spread in the area under the nappy, because it is warm and moist.
It is harder to avoid nappy rash if your baby has runny faeces (diarrhoea), if you can’t change nappies often enough, or if you use plastic pants over the nappy.
Other common causes of nappy rash are:
- fungal infection (‘thrush’)
- allergies (atopic dermatitis, also called eczema)
- other skin conditions such as miliaria (a heat rash), seborrhoeic dermatitis, or psoriasis.
Uncommon causes of nappy rash include:
- more severe types of bacterial skin infections
- infection caused by herpes simplex (the virus that cause cold sores)
- allergic contact dermatitis – when your baby is allergic to something that is directly touching the skin (e.g. an ingredient in a skin cream or lotion).
There are also some rare skin conditions that can look like nappy rash.
Signs and symptoms
Irritant dermatitis (ordinary nappy rash) causes reddening of the skin. The skin may look raw or spotty, and may be sore or itchy. Nappy rash can make your baby irritable or hard to settle.
If your baby’s skin is very raw or weeping, or if there is pus (white discharge) or puffiness, the skin could be infected. Infections in the nappy area often spread to the skin folds at the top of the legs and in the groin.
If your baby also has skin rashes on other areas of the body, these could be due to allergies or other skin conditions.
If your baby has a fungal infection (thrush), it may spread to the baby’s mouth or to your nipples if you are breastfeeding.
Preventing nappy rash
Ordinary nappy rash (irritant dermatitis) is very common, but there are some things you can do to help protect your baby.
- Try to minimise the amount of time that a wet nappy is against your baby’s skin.
- Use very absorbent disposable nappies – these will absorb more fluid than cloth nappies and keep the skin drier.
- If you use cloth nappies, change them every 2 hours and avoid nappy liners.
- Do not use plastic over-pants.
- Let your baby have some time without a nappy each day, if possible.
Cleansing your baby’s skin
- Avoid baby wipes or antiseptic – these can irritate your baby’s skin.
- To wipe your baby’s skin clean, use plain lukewarm water on cotton wool or a soft cloth wipe.
- When you bathe your baby, avoid ordinary soap. Instead, use a soap substitute (e.g. Baby Sebamed Cleansing Bar, DermaVeen Baby Soap Free Wash).
- At bath time, use a bath oil suitable for babies (e.g. Alpha Keri Bath Oil, Pinetarsol Bath Oil, Q.V Bath Oil).
- Don’t use talcum powder on your baby’s nappy rash.
Barrier creams and ointments
- Every time you change your baby’s nappy, use a protective cream or ointment that contains zinc (e.g. zinc and castor oil ointment, zinc compound paste, zinc oxide cream, Desitin Nappy Rash Ointment, Egozite baby cream, Egoderm ointment) or dexpanthenol (e.g. Bepanthen Ointment).
- When you use creams and ointments, apply a thick layer on the skin under the nappy so that the wet nappy will not be able to touch your baby’s skin.
Ask your doctor, Child and Family Health nurse, or community pharmacist for advice.
Usually no tests are needed when your baby has nappy rash.
If your doctor or nurse suspects your baby has a skin infection, they may take a swab to be tested under a microscope. To do this, the doctor or nurse touches a clean cotton swab (like a cotton tip) to your baby’s skin, then puts it into a sealed tube.
Nappy rash treatments
The right treatment for your baby will depend on what is causing the nappy rash and how severe it is.
Ordinary nappy rash (irritant dermatitis) that is mild will often clear up if you follow the advice for preventing nappy rash.
In Australia, several soothing creams and ointments for treating nappy rash are available from your pharmacist without a prescription. These usually contain combinations of moisturisers and dexpanthenol or zinc. Brands include Bepanthen Ointment, Dermaveem eczema cream, Egozite baby cream, Egoderm ointment and Sudocrem. Some creams and ointments should not be used if your baby’s skin has open or weepy sores, so check with your pharmacist first.
See your doctor if nappy rash doesn’t clear up quickly (e.g. in 1–2 weeks) with treatment, or if your baby seems unwell or upset.
More severe nappy rash may need short-term treatment with a mild steroid cream to settle the irritation. This medicine should be used on babies only when recommended by a doctor. Steroid creams and fungal treatments are often used together.
In Australia, medicines recommended or prescribed by GPs and dermatologists (skin doctors) for short-term treatment of nappy rash include combinations of:
- hydrocortisone 1% ointment (e.g. DermAid cream/DermAid Soft Cream)
- methylprednisolone aceponate 0.1% ointment (e.g. Advantan Cream, Advantan Fatty Ointment) – for more severe nappy rash, not for very young babies
- triamcinolone acetonide 0.02% ointment (e.g. Aristocort, Tricortone)
- nystatin cream (e.g. Mycostatin Topical)
- clotrimazole cream (e.g. Canesten Clotrimazole)
- clotrimazole plus hydrocortisone 1% cream (e.g. Hydrozole)
- miconazole plus zinc oxide (e.g. Resolve Nappy Rash).
Your doctor will explain when and how long to use each medicine.
If your baby has a bacterial skin infection, your doctor may prescribe an antibiotic cream such as mupirocin (e.g. Bactroban), or oral antibiotics (tablets).
Where to get advice
Ask your GP or your Child and Family Health nurse for advice about preventing and treating nappy rash.
You can contact a Child and Family Health nurse through your local community health service. Community health services for mothers and babies have different names in different states and territories, e.g, Maternal and Child Health Clinics/Services (ACT and Victoria), Early Childhood Health Clinics (NSW), Child and Family Health Clinics/Centres (Northern Territory and South Australia), Child and Baby Health Clinics (Queensland), or Child Health Centres (Tasmania and Western Australia).
Your community pharmacist can give you advice about nappy rash treatments that are available over the counter.
If you are not sure about what to do, or if your baby’s rash doesn’t improve quickly, see your GP.