Nappy rash

Nappy rash overview

Nappy rash appears on the skin under a nappy. Nappy rash typically occurs in infants and children younger than two years, but the rash can also be seen in people who are incontinent or paralysed.

Almost every baby will get nappy rash at least once during the first three years of life, and the majority of these babies are nine to 12 months old. This is the time when the baby is still sitting most of the time and is also eating solid foods, which may change the acidity of the bowel movements.

Nappy rash causes

• Friction: Nappy rash can be caused by friction that develops when sensitive baby skin is rubbed by wet nappies. This results in a red, shiny rash on exposed areas.
• Irritation: The skin under the nappy gets red from irritants such as faeces, urine, or cleaning agents. Irritation can be caused by the nappy or by the acid in urine and bowel movements. This rash appears red in the area where the nappy has rubbed or where the skin has been in contact with urine and is normally not seen in the folds of the skin.
• Candida infection: The rash of a candida infection, also known as fungal or yeast infection, usually has a bright, beefy red appearance and is very common after the use of antibiotics. Candida is a fungal micro organism that is typically found in warm, moist places such as in the mouth and skin creases. In fact, Candida is the same organism that causes thrush.
• Allergic reaction: The rash may be a reaction to nappy wipes, nappies, laundry detergent, soap, lotion, or the elastic in plastic pants.
• Seborrhea: This is an oily, yellow-coloured rash that may also be seen in other areas of the body, such as the face, head, and neck.

Nappy rash symptoms

Identifying a nappy rash is usually fairly easy. The rash is located on skin underneath the nappy area.

The skin is red and irritated. It may appear all over your baby's bottom or genital area, or only in certain places. It may or may not involve the folds of the skin.

When to seek medical care

It is usually not necessary to call the doctor for a simple nappy rash. Keeping the nappy area clean and dry should prevent most nappy rashes. However, even the best prevention is sometimes not enough.

You should seek medical advice immediately if your baby develops severely inflamed skin, or a fever.

Also seek medical advice if these conditions develop:

• The rash does not get better despite treatment in four to seven days.
• The rash is getting significantly worse or has spread to other parts of the body.
• The rash also appears to have a bacterial infection, with symptoms such as a pus like drainage or yellowish coloured crusting. This could be impetigo and needs to be treated with antibiotics.
• You are not certain what may be causing the rash.
• You suspect the rash could be from an allergy. The doctor can help you pinpoint the possible allergen.
• The rash is accompanied by diarrhoea continuing for more than 48 hours.