By Dr Ananya Mandal, MD
Diaper or nappy rash may affect one in four babies worldwide between ages 6 months to up to 18 months (commonly between 9 and 12 months of age). The symptoms of nappy rash vary depending on the severity of the condition. Most cases of nappy rash only produce mild symptoms.
This type of rash is confined to the area covered by the nappy. There is commonly a closed area of red or pink rash over the convex surfaces of the buttocks and pubic area. These are areas of skin in closest contact with the nappy. The groin folds are commonly spared. 1-4
Mild nappy rash symptoms
In babies with mild nappy rash there is usually the beginning of the pathology:
the rash is usually pink or red spots or blotches
the rash is confined to a very small part of the nappy area.
the child feels generally well and may experience a stinging sensation when passing urine or faeces. This is expressed as the baby crying out loud while passing urine or stool and remaining generally well and playful at other times.
Severe nappy rash symptoms
In case of an more advanced from of nappy rash there may be accompanying pain and itchiness:
the area is extensive and may extend below to the legs or above to the abdomen
there are bright red and large spots
the skin may be dry, broken and cracked in appearance - there may be a bumpy feel and often sores may bleed as well
some babies may develop ulcers (open sores), blisters (fluid filled swellings) and generalized swelling of the nappy area
the baby is usually irritable and may cry as the rash is painful, burning and itchy
Immediate medical attention may be needed if there are additional features like fever, refusal to feed, diarrhoea, pus filled spots etc. these could indicate a more severe infection.
Other conditions leading to rash in the diaper areas
Other conditions that lead to a rash in the diaper area include bacterial infections, Jacquet erosive dermatitis and so forth.
Those with bacterial infections like that with Staphylococcus aureus present with bullous impetigo. There are blisters and pus filled raised spots over the affected area.
Group A Streptococcus infection leads to a red rash around the anus. Other bacteris like E. coli may lead to pain on urination (manifested as the infant crying when passing urine) and vaginal itching, and vulvar inflammation.
Infections with Coxsackie virus causes raised flat red spots buttocks, palms and soles. There may also be open sores at the back of the throat.
Herpes is characterized by painful vesicles in the vulva and area around the anus. Babies with parasitic infestations with pinworms and scabies have intense itching. Scabies also affects other parts of the body like webs of fingers and toes, armpits and groin folds.
Jacquet erosive dermatitis
Those with diaper rash following diarrhoea are said to have Jacquet erosive dermatitis. This is the most severe form of diaper dermatitis and can occur in older babies as well. There are open red sores which are well-demarcated, punched out with raised borders.
Granuloma gluteale infantum occurs due to irritation and secondary infection with reddish purple spots.
Psoriasis shows well-demarked red flat sores. Normally psoriasis shows up with white scarrings and dry patches. This is not seen in diaper areas because of the wetness.
Seborrheic dermatitis shows a yellowish scales over the affected area. Other parts of the body like the head, neck, ears and eyebrows are also affected commonly.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)
Last Updated: Oct 8, 2014