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Nappy Rash

 

Class
Skin
Description
Nappy rash is a term which describes any irritation in the nappy area that causes the skin to become red and sore. Nappy rash is very common and is likely to affect most babies at some time in their first year, particularly when changing over to solid foods or when introducing new foods into their diet. Breast fed babies are less likely to develop nappy rash than bottle fed babies.
Causes
Nappy rash most usually occurs as the result of irritation of the skin through contact with urine and faeces. A baby's skin is thinner and more delicate than an adult's skin and can be easily damaged. Urine softens the skin and makes it more liable to be damaged when the nappy or clothing rubs against it. Ammonia and urea, waste products in urine, also have an irritant effect by raising the pH of the skin and making it more alkaline. The raised pH irritates the skin and reactivates digestive enzymes that are excreted in the faeces, and these enzymes then go on to attack the baby's skin.

Babies who are teething often suffer with nappy rash, probably because they may also have diarrhoea which causes the digestive enzymes to remain active after quickly passing through the gut. Babies who have been on antibiotics are also prone to nappy rash, probably because the antibiotic has upset the natural balance of bacteria in the baby's gut, which again leads to diarrhoea. A change in diet that increases the number of times that a baby passes a motion is also probably a cause of nappy rash.

Sometimes, following the development of the nappy rash, the baby's damaged skin becomes more liable to infection by fungi or bacteria, in particular the fungus Candida albicans that causes thrush.

Other causes of nappy rash include sensitivity to irritants such as washing powders, infant seborrhoeic dermatitis, eczema or a fungal infection such as ringworm.
Symptoms
Non-infected nappy rash appears as a red, sore area starting around the genitals and bottom and spreading to the rest of the nappy area, but is not usually present in the skin creases. The skin may also be blistered and hot to touch.

Infected nappy rash appears as a mostly red rash, which may have white or red spots that leak a straw-coloured liquid. The rash starts around the bottom and usually spreads to the skin creases.

Seborrhoeic dermatitis appears as oily, flaking yellow scales, usually in the groin. Eczema appears as a rash that is highly itching. Eczema can appear all over the nappy area and possibly elsewhere on the body.
Treatment

Medicines

As urine and faeces are the main causes of nappy rash, it is important to change the nappy frequently. Do not allow the baby to lie or sit around for a long time with a soiled nappy on. The longer the nappy is left before changing, the more time that the skin has to become soft and open to attack by enzymes. If possible, take the nappy off all together and allow the air to soothe the baby's bottom.

Clean the baby's bottom thoroughly at each nappy change, do not simply put on a new nappy. Use clean warm water with a small amount of baby soap. Avoid using baby wipes and talcum powder. Pat the area dry with a soft towel, do not rub. If you think that your baby's bottom is irritated by the nappy, try changing your brand of nappies or try changing from towel to disposable nappies. If you use towel nappies, do not wash them with biological washing powders as the enzymes in these powders may be the cause of the irritation to the baby's skin.

Creams such as zinc and castor oil cream, Drapolene, Metanium and Sudocrem can be applied to the affected area to act as a barrier to urine and faeces, and to help soothe the irritation. If there is fungal nappy rash, creams or powders containing the antifungal agents clotrimazole or miconazole will help treat the infection. If the area is particularly inflamed, your doctor may decide to prescribe a weak hydrocortisone cream.
When to consult your pharmacist
Talk to your pharmacist if you are concerned about your baby's nappy rash. Your pharmacist will be able to give advice about how to avoid getting nappy rash and what to do if your baby has nappy rash. All of the creams to prevent and treat nappy rash can be obtained from your local pharmacy without the need for a prescription. If your baby has suffered from nappy rash for a long time and your pharmacist thinks that there may be an infection, you will be advised to visit your doctor who may decide to treat the infection with oral antibiotics or oral antifungal agents.
When to consult your doctor
If your baby's nappy rash does not clear up or worsens, it is important that you take your baby to see the doctor.
Useful Tips
  • Let your baby play without a nappy on for short periods
  • Change nappies regularly
  • Cleanse and dry the skin thoroughly, especially the skin folds
  • Dry your baby's skin gently by patting rather than rubbing because this could damage the skin or make nappy rash worse


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