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What is it?
Where does it occur?
What causes it?
How is it treated?
Further information

important points
The nappy area needs to be kept as dry as possible
Change nappies often
Mild redness of the skin often settles if no nappy is worn
A child without a nappy should not be left lying in urine or faeces
Plastic overpants should not be used if nappies cannot be changed regularly
The nappy area can be cleaned with warm water or a moisturising cream such as sorbolene or aqueous cream
At each nappy change a water repellent moisturiser such as zinc and castor oil cream or vaseline can be applied as a barrier
Avoid the use of soap on the skin
Add a small amount of unperfumed bath oil to the bath
Avoid adding antiseptics and other chemicals to the nappy rinse

what is it?

Nappy rash is a term used for inflammation of the skin that occurs in the nappy area. Almost all babies develop it at some stage when they are in nappies. It can vary from mild redness to quite severe inflammation sometimes with weeping and crusting. It tends to be due to a combination of factors, but the most important one is related to the wearing of nappies, as the name suggests.

where does it occur?

Clearly nappy rashes occur in the area where the nappy is being worn, i.e. in the groin, on the buttocks and on the thighs. The rash occurs only at points of direct contact of the nappy with the skin.

Occasionally there can be associated rashes away from the areas where the nappy is being worn. This may indicate that there is some other disease such as eczema, which is part of the underlying problem that makes the baby have a tendency to nappy rash.

what causes it?

The primary cause is the presence of a wet or dirty nappy in contact with the child’s skin. The moisture, plus the friction of the nappy against the skin irritates it and causes the inflammation. This is more likely to happen if a child has sensitive skin already, e.g. it has a tendency to eczema.

Once the surface of the skin is affected and inflamed secondary infection with bacteria and thrush (candida) can also play a part. The use of irritants such as soap and alcohol based nappy wipes can also keep it going or make it worse. The longer wet nappies are left on the skin between nappy changes, the greater are the chances of a nappy rash occurring.

how is it treated?

If the nappy is not in contact with the skin, the rash should not occur. Leaving the nappy off when possible will help clear the rash. However it is not practical to leave a child without nappies all the time. Therefore, nappy changes should be as frequent as possible. If the child is left without a nappy, it should not be left lying in urine or faeces. Plastic overpants should not be used if the nappies cannot be changed regularly.

High quality absorbent nappies are the ideal. Cloth nappies should be adequately washed and rinsed. If chemicals such as antiseptics and biological detergents are used they should be thoroughly rinsed out. Fabric conditioners should be avoided when washing nappies.

When the nappy is changed, the skin can be cleaned with warm water or a moisturising cream such as sorbolene or aqueous cream. Soap should be avoided as it will further irritate the inflammation or alter the skin barrier creating a tendency towards inflammation if it hasn’t occurred already. Once the nappy area has been cleaned, the skin should be gently patted dry rather than rubbed, and then a water repellent moisturiser such as zinc and castor oil cream or Vaseline can be applied.

If a mild nappy rash does not settle with simple treatment, or if it becomes severe, then a doctor’s advice may be necessary to determine whether cortisone creams or anticandida treatments are necessary. The doctor may also determine whether there is an underlying tendency to eczema which is causing the child to develop the nappy rash. Any eczema will need to be treated and measures taken to prevent its return in the long term.

further information

Your Maternal and Child Health nurse.
Your pharmacist.
Your family doctor.
A dermatologist.

© 2002, Department of Dermatology, St. Vincent’s Hospital Melbourne, Victoria Parade, Fitzroy, Victoria 3065 Australia.