What is napkin dermatitis?
Napkin dermatitis and nappy rash are used to describe various skin conditions that affect the skin under a baby's napkin. The US term is diaper rash.Napkin dermatitis is most often a form of contact dermatitis.
Napkin dermatitis can also affect adults that wear incontince pads or panties.
What is the cause of napkin dermatitis?
Napkin dermatitis follows damage to the normal skin barrier associated with wetness.
- Warmth and moisture may cause a rash in the skin folds. This is often seen in babies with cradle cap and infantile seborrhoeic dermatitis.
- Chafing due to the napkin rubbing on the skin. This tends to cause a rash where the napkin is tight at the waistband and around the legs.
- Irritant contact dermatitis: urine and faeces will cause a rash on any skin left in contact for long enough. Sometimes ammonia is formed and results in a chemical burn. This affects the skin in contact with urine and faeces, sparing skin folds. The edge of irritant contact dermatitis is well defined. The skin surface is a dull red colour.
- Infection candida yeasts (thrush). The rash is bright red, raised with well defined edges. There are often small satellite spots or superficial pustules around the main rash. Thrush is particularly common after a course of broad spectrum antibiotics.
- Infection with bacteria results in impetigo, in which there are irregular blisters and pustules.
- Other skin disorders: psoriasis and atopic dermatitis can affect the napkin area.
The nappies themselves are not responsible for nappy rash. Washing powder or nappy cleanser isn't either, as long as the nappies have been thoroughly rinsed to remove the chemicals.
How to prevent and treat nappy rash in babies
- Use disposable nappies if possible. Those containing absorbent hydrocellulose gel are excellent at keeping urine away from the skin.
- If you use cloth nappies, use nappy liners to keep the skin dry. Make sure the nappies are rinsed well after washing. Do not apply plastic pants over cloth nappies; use woollen pilches or 'bunnies' instead.
- Change the nappies frequently – do not leave your baby in a wet or dirty nappy.
- Give evening fluids early to reduce wetting at night. Change the baby before you go to bed yourself.
- Observe whether certain foods are related to the rash by increasing stool acidity (eg orange juice) or frequency. If this is the case, discontinue the responsible food, at least temporarily.
- Wash the baby's bottom at every change. Use warm water to remove all urine and bowel motions. Soap and wet wipes might sting if a rash is present; use aqueous cream or a bath oil instead. Pat dry carefully. Corn starch powder can be used if the skin still feels moist.
- Moisturise dry skin at every nappy change. If the skin feels dry, apply an non-irritating emollient to all affected areas. This can be nonionic cream, fatty cream, a mineral oil or wool fat lotion, zinc and castor oil cream, or another favourite. Dimeticone (Silicone) barrier creams can also help.
- If the rash is severe or persistent, see your doctor. Apply prescription creams according to directions. The doctor may have prescribed a mild topical steroid and/or antifungal cream. It should be applied once or twice a day. Do not apply it to normal skin. When the rash has cleared up completely, do not continue to apply the topical steroid. The anti-yeast preparation should be applied for a least a few days more than it takes to clear the rash. Ask your doctor if you are not sure how, when and where to apply the cream(s).
- Strong steroid creams should not be applied to a baby's bottom.