Nappy Rash

Nappy rash is a skin inflammation. Most cases are due to a reaction of the skin to urine and motions (faeces). In addition, a germ called Candida commonly thrives on the inflamed skin. (This is the germ that causes thrush.) Candida can cause a more inflamed rash which may include darker red spots spreading around the nappy area ('nappy thrush').

Most nappy rashes are mild or moderate, and are not serious. Occasionally, skin conditions such as eczema, psoriasis, infections, and some rare skin diseases cause unusual nappy rashes.

• Leave the nappy off as much as possible to let fresh air get to the skin. Obviously, you cannot leave the nappy off all the time. However, the more fresh air, the better. Try lying the baby without a nappy on a towel or disposable absorbent sheet for a while each day. (But change the towel or sheet as soon as it becomes wet.)
• Change the nappy often. Ideally, change the nappy as soon as it is wet or soiled. The aim is to prevent urine and motions being in contact with the skin for long periods.
• Wash the baby's bottom with water only. Soaps may irritate the skin, so water alone is best. Non-alcoholic 'wet wipes' are an alternative if you are out and about.
• After washing, make sure the bottom is properly dry before putting on a new nappy. Dry by patting, not by rubbing, with a towel.
• Do not use powder such as talcum powder which may irritate the skin.
• Barrier creams or ointments may help to protect the skin from moisture. Ideally, rub on a thin layer of barrier cream or ointment just before putting on each nappy. Do not apply too much as this may reduce the breathability of the nappy.
• Don't use tight fitting plastic pants over nappies. They keep in moisture and may make things worse.

The above measures are likely to clear a mild rash. If the rash becomes worse, a doctor or health visitor may advise one or both of the following in addition to the above measures.

• A mild steroid cream or ointment such as hydrocortisone. Steroids reduce inflammation. Apply sparingly once a day (before using a barrier cream) for a few days until the rash has cleared. A steroid cream or ointment should not usually be used for more than seven days.
• An antifungal cream (which kills candida). This is typically applied 2-3 times a day. Unlike a steroid cream, continue to use an antifungal cream for 7-10 days after the rash has cleared to make sure all the candida germs have gone.

Sometimes the inflamed skin of a a nappy rash becomes infected with bacteria (other types of germs). This may be suspected if the rash becomes worse, despite using the above treatments. In these cases an antibiotic medicine may be needed. Therefore, if a nappy rash does not improve with the usual treatment described above, then see your doctor.

© EMIS and PIP 2006   Updated: September 2006   PRODIGY Validated