Nappy Rash

WHAT NOW

3 min read

A nappy rash is one of the most common skin rashes and about 35% of all infants get it at least once or twice within the first year of life. It is mostly seen from 9 - 12 months. The acidic components of the stool, bacteria of the stool, ammoniac from the urine and wet damp surrounding add to irritation of the nappy area. The stratum corneum is hyper-hydrated and allows bacteria and irritable substances to pass the skin barrier more easily. Another component is using the wrong cleansing products. Additionally, if these are not fully rinsed, they can contribute to nappy rash. Babies who have atopic eczema are particularly vulnerable, also those who are at the beginning of an infection, are teething or taking antibiotics. Moreover, a secondary fungal or bacterial infection can be caused by the damp and wet surroundings, if not treated correctly (16). The pH, proteases (enzyme which breaks down proteins and peptides) and lipase (enzyme which breaks down fat) of breast milk stool is lower than in formula fed children, which leads to less irritation of the skin in breast feed children (17).  

Appearance

  • reddish area with a blurred outline

  • area where the nappy sits, groin area or starting from the perianal region

  • the area is oedematous, sometimes with pimples and blisters

What one can do 

  • Seek help from your midwife or pediatrician, if symptoms worsen, the baby shows pain whilst cleaning or the symptoms persist over a period of more than three days.

  • Change nappies frequently and give your baby nappy free time in a warm surrounding.

  • If the nappy area is just slightly reddish, one can take a clean compress soaked in breast milk and put it on to the area for a few minutes - though one should make sure that the area also gets time to dry before closing the nappy again.

  • One can also try healing wool, which is natural sheep wool and still contains lanolin. It has a soothing effect on irritable skin, supports regeneration of the skin and is able to absorb fluid. No additional cream or ointment should be used otherwise the wool will not absorb as well. One should also put a net like compress on top of it - so that open wounds do not merge with the fibres of the wool (18). If buying healing wool, it should be pesticide free, from organically held animals. One should change with every nappy change. It should not be used on babies with other dermatitis since one may connect it to a contact allergy to lanolin (19).

  • One can try black tea compress, since black tea has antibacterial function, due to the tannin contained (20).

  • One can try chamomile tea as a sit bath, since chamomile also has some antibacterial and antiseptic functions (21).

  • If one uses cream or paste, make sure to apply a thin layer and do not wipe rest of the cream or paste onto the nappy, as the nappy won’t absorb fluid in that area.

  • One should not wipe over the skin, one should pat the nappy area clean and pat it dry (22).

  • Also olive oil can be used to clean dried stool, but shouldn’t be used as a care product since it dries out the skin and can irritate it (23).

  • A study by the School of Nursing, Midwifery and Social Work of the University Manchester showed no significant difference between the usage of perfume free wipes compared to just water and cotton compresses (24).

  • If one uses wipes, one should make sure not to use any with perfume or alcohol (25)!

  • One can try using zinc paste, after consulting a pharmacist

  • One should never dry the baby’s bottom with a hairdryer. It makes the skin even drier, and can be too warm for the baby even if one does not think so. Additionally, if the baby passes urine it could reach the hair dryer and one could get an electric shock (26)!

  • The usage of baby powder has been no longer recommended since 2009, by Dr. Geiz, due to evidence that the powder particle could be inhaled by the baby and damage the airways (27).

  • If a secondary fungal infection appears, make sure to take a look in your baby’s mouth, since this often also appears together. When this is the case you should consult your paediatrician.

It is important to keep in mind, to not give up on one point after using it one or two times. The irritated skin needs time to heal. 

Additional Sources