Nappy rash - Treatment, causes and prevention

Baby nappy rash is a common rash that leaves a region of irritated skin in the nappy area. Common symptoms of nappy rash include:

• Skin that appears red, rough and bumpy or spotty, and sometimes hot to the touch
• Can be localised or spread over a large area

Mild nappy rash
Often mild nappy rash doesn’t bother babies too much and may not cause them pain. However, it should still be treated to prevent it worsening.

Severe nappy rash
More severe nappy rash can cause itchiness, pain and discomfort, possibly leading to blisters, broken skin and bleeding. If your child has a severe nappy rash, please seek medical assistance.

It is assumed that as many as one-quarter to one third of babies and toddlers suffer from nappy rash at any given time (Source: NHS England).  It most commonly affects babies between the ages of 9 to 12 months.

Nappy rashes are most commonly caused by moisture trapped for an extended period of time in the nappy area. A baby’s skin is more sensitive than an adult’s, making it more prone to developing a rash in these cases. Nappy rash can have a number of different causes, including:

• Too much time between nappy changes, which leaves a soiled nappy rubbing against the skin
• Poorly fitting nappies, particularly nappies which are too small and chafe your baby’s delicate skin. This can also make an existing nappy rash worse
• Diarrhoea. This is partly because it can be harder to keep a baby’s bottom clean after diarrhoea, and partly because the wetness of the stool can cause problems
• Antibiotics. Nappy rash can be caused by thrush, which your baby is more likely to develop if they are on antibiotics for another condition
• Allergies to products such as baby wipes, certain toiletries or laundry detergents. This can cause irritation which is made worse by nappies

Some babies may be more susceptible to rashes than others. Just remember that the occasional nappy rash on your baby does not make you a bad parent!

Hand foot and mouth disease, common in children, can also cause a rash in the nappy area of a baby or child. Other symptoms can include mouth ulcers, a high temperature and a rash or blisters on the hands and feet.

Whilst not a direct cause of nappy rash, any increase in moisture makes it more likely. When a baby is teething, they may also suffer from diarrhoea, which leads to more opportunities for moisture to cause irritation in the nappy area, leading to nappy rash.

To reduce the chances of this happening, try to change nappies as soon as your baby has done a poo, and keep the nappy area clean and dry.

Another way to support the healing process is to try giving your child a little bit of “nappy-free” time each day in order to reduce the contact time with nappies while ensuring a bit more comfort for your baby. You could do this by extending their nappy-off time at the end of a change. If the weather’s warm and they can crawl or walk, you could allow them to move around in a safe outdoor space without their nappy on for a little while.

If the rash does not seem to be improving, you have further questions, or if it might be caused by other reasons please consult your child’s paediatrician. It may be necessary for them to prescribe some form of medication, such as a steroid cream or antibiotics.

Be cautious when using lotions or creams that are not specifically recommended for babies and children as they can worsen the rash even further.  You should also avoid over-bathing, as excessive washing can dry out a baby’s skin and heighten irritation. One bath a day should be plenty, or two at most. When you do bath your baby, keep it simple and don’t use bubble bath as any extra products can make things worse.

The NHS says that if you follow this guidance, most nappy rashes should clear up in about 3 days.

One old-fashioned “home remedy” for nappy rash is applying egg white to the area. We don’t recommend attempting this; stick to tried and tested methods like those suggested above.

You can help minimise the risk of nappy rashes by

• Ensuring that your baby is always wearing a clean, dry nappy.
• Updating the size of your baby’s nappies as needed to reduce rubbing, as infants grow quickly.
• Applying the Elastoplast Wound Healing Ointment to the nappy area. The ointment creates a breathable protective film that prevents nappy rash and protects from soreness caused by sweat, faeces and urine.
• Using super-absorbent nappies, which can help to keep excess moisture away from direct contact with your baby’s skin.
• Being mindful of the products you’re using on your baby. Avoid talcum powder as it can irritate the skin; use a cream like Elastoplast Wound Healing Ointment as a barrier cream following changes instead. You should also avoid scented baby wipes - it’s best to stick to cotton wool and water if you can.
• Drying your child gently but thoroughly after baths. Make sure you get in all those creases!

If you suspect that your baby’s rash is caused by an allergic reaction, or if you are uncertain, speak to your paediatrician immediately as it could be a symptom of a more serious allergy.

Adult nappy rash can occur in anyone who wears adult nappies or incontinence underwear, although it’s less common than nappy rash in babies.

The symptoms of adult nappy rash are very similar to those experienced by children, including a red or pink rash and possible broken skin and blisters in more severe cases.

Recommended treatment for adult nappy rash also involves applying an ointment such as Elastoplast Wound Healing Ointment. The affected area should be allowed to air out occasionally without a nappy.