What is nappy rash (or diaper rash)?
Nappy rash occurs mostly in babies and is an irritation of the skin (nappy or diaper dermatitis). Nappy rash is not a disease, but merely an inflammation of the skin.
A common condition, it can affect up to 35% of children under the age of two, with many experiencing it at least once before they are toilet trained. Nappy rash can also occur in adults too, especially those unable to use the toilet on their own.
The inflamed area of skin causes an uncomfortable burning (warm) sensation and redness as a result of coming into contact with or rubbing against a nappy (diaper).
What to expect
Nappy dermatitis results in red patches developing on the surface of the skin (a rash). The whole nappy area could become red and inflamed too. The skin may feel warm or hot to the touch and appear quite sore.
A case of mild nappy rash may not be painful or sore, but if severe, will likely be very uncomfortable, especially if spots, pimples (white or red) and blisters form as well as a moist rash. These spots, pimples or blisters can spread into the folds of the skin due to infection. Babies can become very distressed in severe nappy rash cases.
How to tell the difference between nappy rashes:
- Is the nappy rash red, but not bright red? In this case, only a sting when the nappy area is wet will be felt. The redness may not reach into the folds of the skin. Inflammation usually clears within a few days.
- Is the nappy rash bright red? This is usually as a result of a fungal infection. Inflammation can extend into the folds of the skin where fungus can grow too. Spots located further out on the buttocks may also be present.
- Is the nappy rash bright red, very warm to the touch and the area swollen? This occurs as a result of a bacterial infection, often accompanied by fever.
Factors to consider
Nappy rash most frequently occurs when someone sits for too long in a soiled nappy (or diaper). Human waste (urine and faeces) can turn into ammonia if left in contact with the skin for too long, causing irritation.
Diarrhoea (loose, watery stools or the frequent need to have a bowel movement) can become problematic for a baby or adult wearing a nappy. Diarrhoea can be acute or chronic, but in most cases, can last up to a few days, clearing up without treatment.
Generally, babies soil their nappies every 2 to 4 hours. This is one of the main reasons why it is important for them to be frequently changed. Human waste is acidic in nature, allowing bacteria and yeast to thrive. When this happens, inflammation and irritation of the skin occurs.
A candida fungus skin infection can also occur whereby a strain of fungus causes an infection on the skin. The skin may host small amounts of this fungus which thrive on the skin and become problematic when it starts to multiply, creating overgrowth. The majority of infections are caused by a species known as Candida albicans. Other types of candida fungus skin infections are athletes foot, oral thrush, nail fungus, vaginal yeast infection and jock itch.
Every person has fungi on their skin. Irritation occurs when the conditions are just right for it to grow (due to dampness and changes to the skin). It doesn’t necessarily only grow due to poor hygiene. Bacterial infections can also occur if there’s a small scratch on the skin or if the skin has already been weakened by a rash, allowing bacteria to grow easily and cause an infection.
Other known types of skin rashes which can be agitated by wearing a nappy include other forms of dermatitis, psoriasis, as well as rashes caused by syphilis, HIV/AIDS and bullous impetigo (a skin condition caused by a bacterial infection).
Other common causes of nappy rash are:
- The nappy constantly rubs against the skin while being worn. Sometimes a nappy that is too tight or doesn’t fit properly can result in chafing of the skin. The nappy should allow air to get to sensitive areas. A baby can sometimes go without wearing a nappy during naps to give their skin a break.
- The nappy area is not cleaned frequently or changed often enough.
- The nappy area is cleaned with soaps, chemicals, detergents or even bubble bath which can cause irritation to sensitive skin.
- The nappy area is cleaned using alcohol-based or perfumed baby wipes. These can cause drying, and thus worsening symptoms of inflammation / infection.
- A baby or adult may suffer a reaction to prescribed antibiotics.
Who is at risk?
Up to a third of children under the age of 2 can develop nappy rash. Newborns who are breastfed are at lower risk of experiencing nappy rash as their diets are not normally highly acidic. Even if exposed to a diet that is low in acidity, a breastfed infant or toddler who wears a nappy can still develop a rash for any of the other above-mentioned reasons.
Nappy rash in babies is generally not problematic until the age of 3 weeks. Risk is highest for babies between 3 months to a year, particularly once they begin solid foods. It has been known for nappy rash to be passed from infant to infant (sharing an unclean nappy).
Diagnosis, Treatment and Prevention
When to call the doctor
If the nappy rash is bright red, lasts for more than 48 hours or is accompanied by a strong urine odour (which can indicate dehydration), it is recommended to see your doctor.
If the rash forms blisters (which contain clear fluid) or becomes ‘weepy’ (leaking of clear fluid which can dry out and form a thick crust), a fever develops, you notice a bright red ring around the anus, skin falling off in big flakes, or you notice any bleeding, it is best to see your doctor as soon as possible.
Most who care for young children or the elderly can recognise and identify nappy rash when they see it, and treat accordingly. Where the rash is more severe, a doctor will offer their expert opinion, as well as offer any necessary prescriptions and other baby item suggestions (such as other nappy alternatives – cloth or disposable). These kinds of rashes tend not to clear up without physician-prescribed ointments and lotions.
Nappy rash as a result of a yeast infection often occurs in infants or adults taking antibiotics.
Treating nappy rash and home care
Creams made of plant derivatives, such as aloe and calendula, can help alleviate inflammation and bacteria on the skin. Other recommended topical creams which your doctor can help guide you in how to use include:
- Hydrocortisone creams (this topical corticosteroid relieves swelling)
- Antifungal or antibiotic creams (oral antibiotics may also be prescribed to clear the infection)
- Zinc oxide
- Other steroids
Nappy rash, although highly uncomfortable, is not life-threatening and so occasional bouts of infection can easily be treated at home. Key to treatment is the use of over-the-counter ointments and medications, as well as smart practices in the home environment.
Nappy rash usually clears up in a matter of days if you practice good hygiene and take precautionary measures to minimise the occurrence of infection.
Preventing nappy rash
Prevention is better than cure, and there are plenty ways to minimise or prevent the occurrence of nappy rash. It’s all about taking the best care of very sensitive skin.
Things you can keep in mind to help prevent, as well as treat nappy rash include:
- Applying a thin layer of barrier cream to help protect the skin. A pharmacist or medical professional can assist with recommending one for you and advise on how to use.
- Changing soiled nappies (wet or dirty) as soon as possible.
- Gently, but thoroughly cleaning the entire nappy area, wiping from front to back. Fragrance-free and alcohol-free wipes or clean water are best, and won’t dry out the skin.
- Bathing daily. It is best to avoid bathing a baby more than twice a day as their skin does tend to dry out easily.
- Drying the nappy area gently after washing, taking care to avoid rubbing vigorously.
- It is a good idea to lie a baby down on a clean towel once dried, leaving their nappy off for as long as possible, to allow fresh air to get to their skin.
- It is best to avoid using talcum powder as it does contain ingredients prone to irritating a baby’s sensitive skin. Some doctors recommend using corn starch instead.
How long does nappy rash last?
With proper care and hygienic treatment, rashes clear up within 3 days. If the rash does not heal with treatment, a yeast or fungal infection (Candida) could be the main cause.
In this case the rash becomes bright red and raw, and the inflamed nappy area can be large and covered in red dots. It is best to seek assistance from a medical professional to determine the cause and sufficiently treat the infection.
Do babies get nappy rash when teething?
A nappy rash is a common occurrence during a baby’s teething stages, and has been known to worsen. It is not clear why teething and nappy rash are so closely (and commonly) linked.
One thought is that during teething the baby produces more saliva in the mouth. This then has an impact on changing the nature of the baby’s poo / stools. Faeces (or stools) are one of the main concerns which cause an infection when touching this sensitive area of skin for too long.
Is nappy rash a fungal/yeast infection?
When the skin begins to show signs of inflammation caused by irritants in a dirty or soiled nappy, Candida albicans (Candida) can grow, resulting in a fungal infection. A fungal nappy rash is particularly unpleasant, even painful, as the skin ‘stings,’ particularly while wearing a soiled nappy. It is very important to change nappies (diapers) frequently.