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What is diaper rash (nappy rash)?

By Dr Ananya Mandal, MD

Diaper rash (also known as nappy rash) is called diaper dermatitis is medical parlance. It is a common condition affecting up to a third of babies wearing nappies at any given time.

The condition leads to sore, red and irritated skin around the nappy. The commonly affected areas include the convex surfaces of the buttocks and the bulge of the groin. Nappy rash may spare the groin folds.

It was found that diaper rash accounts for 4.8 million outpatient visits in the eight-year period from 1990-97. This shows that infants are estimated to have a one-in-four chance of developing diaper rash. In addition around 75% of the affected babies were brought to the paediatrician for management. 1-5

Symptoms of diaper rash

There may be pink or red spots or blotches over the area and on the whole the area may appear red and swollen. The most common time when a baby suffers from nappy rash is when they are between 9 and 12 months of age. Usually there is no pain or discomfort.

Most cases the symptoms are mild and it is termed mild nappy rash. Babies with mild nappy rash show a small part of their nappy area to be covered in pink or red rashes. These babies tend to feel a stinging sensation when passing urine or faeces and tend to cry out loud.

In babies with severe condition or accompanying secondary bacterial infections over the affected area there may be pain, itching or discomfort that leads to increased irritability and crying. The affected area shows bright red spots, dry, cracked and broken skin and ulcers, blisters and swellings over the skin.

The affected area is also more extensive and may extend to the legs below or abdomen above. A fever or refusal to feed is usually a warning sign when the physician needs to be contacted urgently.

Causes of diaper rash

Nappy rash is commonly caused when the baby’s skin around the groin and nappy area becomes exposed to urine and faeces in their nappy. It is found that the ammonia in the waste products may irritate the baby’s soft skin. If a soiled nappy is left on for a long time this kind of skin irritation is seen.

Sometimes nappy rash is also caused by a fungal infection. Since the nappy area is warm and damp for long periods of time, it can cause a fungus, known as candida, to grow. This infection also irritates the baby’s skin and leads to reddish rash and features of nappy rash.

Babies with allergic tendencies, skin allergies like eczema, seborrhic dermatitis (types of dandruff that affects scalps of babies), psoriasis, allergic dermatitis, bacterial skin infections etc. all may manifest with rash and redness around the nappy area.

Treatment and prevention of diaper rash

Most cases of nappy rash are detected early and are termed mild nappy rash. These can be treated using simple skin care methods. The nappy must be kept off the skin for as long as possible when the area is affected.

The baby may be made to lie on a towel or disposable absorbent sheet that is changed frequently as he or she soils it.

Ideally for prevention of nappy rash the nappies should be changed frequently. The baby’s bottom and nappy area should be washed with water and dried completely before putting on a new nappy.

There are barrier creams and ointments available at pharmacies over the counter to protect the skin from moisture. Severe cases of diaper rash may require steroid cream or ointment such as hydrocortisone for reduction of inflammation, an antifungal cream which kills Candida and even antibiotic ointments that fight bacterial infections.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Oct 8, 2014

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