Diaper rash: Causes, prevention, treatment

Diaper rash, sometimes called nappy rash, is an uncomfortable skin condition where urine and stool cause the delicate skin around the bottom and groin to become irritated. Learn more about the symptoms, causes and treatment in our guide.

What is diaper rash?

Diaper rash is fairly common among babies, with around one in four people reporting the condition, and likely more who manage it without seeing a doctor. It is most common in babies between around seven and 12 months old. Diaper rash is a form of dermatitis linked to nappy-wearing and incontinence.

Poo and pee are irritating to the skin and can cause red, inflamed areas anywhere that they are held against the skin for any length of time. This can include the bottom, groin, genitals, and sometimes slightly onto the thighs. It may be particularly sore in the creases around the groin, where the skin is more likely to stay moist and where the skin can form cracks and fissures.

Although we tend to associate diaper rash with babies, irritation from urine and faeces can affect anyone who is regularly incontinent, especially if they don't always get clean and dry quickly afterwards. Wearing incontinence pads can help keep clothes dry but can make the rash worse as they can hold the pee and poo against the skin and make it damp and sore.

Symptoms of diaper rash

Nappy rash doesn't always seem to be painful, but sometimes individuals can seem uncomfortable with a bad case of diaper rash. The symptoms of diaper rash are usually quite straightforward and can include:

• A visible rash which affects the areas that regularly get wet inside a nappy. Diaper rash is usually very visible as red, sore-looking skin in areas that get wet and dirty when the baby's wearing a diaper.
• Baby reaching for or scratching the areas with the rash. Diaper rashes cause soreness and itchiness, so you might find your baby reaching for sore areas. Older babies and toddlers can sometimes be seen scratching at them.
• Baby crying more than usual, and being especially irritable while getting their nappy changed.
• A rash with small spots or pimples.

Causes of diaper rash

Nappy rash is caused by poo or pee being in contact with delicate skin for too long, so leaving nappies for too long after becoming wet or dirty can be a problem. Not getting the area under the nappy fully clean and dry before putting a nappy on can cause nappy rash too. It can also be caused by poorly-fitting nappies rubbing against the skin, particularly as the baby becomes more mobile. Some harsh baby wipes or bath products can cause irritation for babies with sensitive skin too.

Sometimes introducing new foods can cause sensitive skin to flare up or can make a baby's poo more runny, meaning that it's more likely to cause nappy rash. If you're concerned about any food sensitivities when weaning or as the baby tries more new foods, it's a good idea to ask your health visitor or doctor.

Some babies naturally have more sensitive skin than others. As such, a baby getting nappy rash doesn't necessarily mean that the parents are doing anything wrong; they may just need to take extra care of babies with particularly sensitive skin.

Some medications can make a baby more prone to nappy rash. For instance, if they've been given laxative medication for constipation, that can make it more likely that skin will be irritated by looser poo.

Antibiotics can also make a baby more prone to have nappy rash, partly because it changes the delicate balance of natural microbes on the skin and in the poo, and partly because they can cause softer poo or diarrhoea which is more likely to irritate and damage the skin.

Potential complications arising from a diaper rash

The main thing to watch out with diaper rash for is a bacterial infection. A wound with redness spreading to the healthy skin around it, which is very hot to touch, or which is oozing pus, is likely to be infected. Your doctor may prescribe antibiotics for such cases. Infections that start in the skin can also begin to affect the whole body, with fevers, chills, and where the child may begin to seem generally unwell.

Diaper rash can also be complicated by a fungal infection (Candida albicans or 'thrush'). Fungal infections thrive in moist, warm areas of the body and sore, broken skin can allow it to spread quickly. Thrush is painful and very itchy, causing the skin to look very red and shiny with white flecks that can be removed by cleaning.

Thankfully, the condition is usually easily treated with creams and ointments.

Thrush is also more common when a child is or has recently been on a course of antibiotics, so just when a bacterial infection seems to be clearing up, a fungal infection may take its place.

How can you prevent a diaper rash in your baby or loved one?

1. Having regular 'bare bum time'

A chance for the baby to go naked for a little while. It’s important that the baby still stays warm enough, and it’s a good idea to schedule bare bottom time for just after baby’s had a pee and poo. Having a little time with a nappy off means that clean skin can get nice and dry, and there’s no chance of anything rubbing or holding moisture against the skin.

2. Making sure the skin is properly cleaned and dried

And has a fresh diaper on as soon as possible after it becomes wet can help prevent diaper rash

3. Cleaning with very gentle products

Adding warm water to a soft cloth can do the trick, but you can also buy baby wipes that are suitable for very sensitive skin. Some bath products like bubble baths, soaps and shampoos can also irritate a baby’s skin, so mainly cleaning with warm water is best, or using only small amounts of products designed for a baby’s sensitive skin when necessary.

4. Regular baths

Bathing a baby too often and with harsh products can dry out the skin and make nappy rash worse. However, having regular baths, perhaps once a day as part of a relaxing bedtime routine, with just warm water and minimal use of products, can help keep skin clean and comfortable.

5. Drying gently

It’s essential to allow skin to dry thoroughly before putting on a fresh nappy. However, rubbing your baby’s bottom dry with a towel can be damaging. Gently patting dry with a soft cotton cloth and allowing a little bare bum time for drying can help to prevent nappy rash.

Treatment of diaper rash

Nappy rash can usually be prevented and treated at home without any specialist treatment. Here are some ways to treat a diaper rash at home:

1. Creams and ointments 

These are widely available in supermarkets and pharmacies, and a pharmacist or pharmacy assistant can give you advice about which one will be best for your baby.

2. Taking extra care of hygiene

Keeping the skin under a nappy clean and dry can help prevent nappy rash, and also can help existing nappy rash to clear up.

3. Daily baths

With minimal use of bath products, this can help keep skin nice and clean and prevent rashes. If your baby is prone to dry skin or eczema, a doctor may recommend emollients. These can be used as alternatives to soap and will keep your baby’s skin supple and healthy, preventing broken skin, cracked skin and rashes.

4. Change your nappies

It isn’t always clear why, but some nappy brands may suit some babies more than others. It may be a matter of one type fitting better than another, or some being more breathable than others. If you use cloth nappies, try different sizes of plastic covers, or leave them off altogether.

Prevention is always better than cure, so following hygiene advice and using a barrier cream for babies who are prone to diaper rash can help keep it at bay.

When should you bring your baby or loved one to a doctor?

Diaper rash can usually be managed at home with simple treatment and preventative measures. Sometimes, though, it can be problematic and require medical treatment and advice. It’s important to see a doctor if:

• The rash is very hot to touch, with very red skin around the rash.
• The rash is spreading rather than improving with home treatment
• The baby becomes generally unwell with the rash, especially if they have a fever. Signs that baby is unwell can include fever, shivering, unmanageable crying and distress, or becoming unusually sleepy. If baby becomes unresponsive or floppy, that’s a medical emergency.
• Pus is oozing from the wound.

If the diaper rash is hard to manage or continues to get worse despite home treatments, a pharmacist, health visitor or doctor will be able to recommend treatments and give advice. If there are signs of infection such as very hot red skin around the rash, open wounds, pus or other fluid weeping from the sores, or your baby develops a high temperature, it’s important to see a GP as soon as possible.

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This article was first published in Homage.