Is it really nappy rash?
While nappy rash is a common complaint, it's important to know exactly what you're dealing within order to know how to treat it.
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While the term “nappy rash” is a blanket expression for any skin complaint that happens in a baby’s nappy area, there isn’t only one kind of nappy rash. It most commonly falls under one of three skin conditions – contact dermatitis, eczema or thrush.

Contact dermatitis

According to Cape Town-based paediatrician Dr Paul Sinclair, a major cause of nappy rash is skin irritation caused by urine. “While a baby girl would get inflammation on her external labia if left in a wet nappy for too long, a baby boy would get it on his contact area.

This kind of a rash is related to ammonia burn (every baby has ammonia in his or her urine which is acidic and can burn the skin) and this is why a nappy needs to be changed regularly,” he urges.

Read: What is cradle cap?

“Yes, the nappies these days are super absorbent, but this doesn’t mean they should be left unchanged for hours on end. Even after one wee, uric acid is present in your baby’s nappy, which could cause irritation on his skin.”

Urine aside, babies who get diarrhoea – and particularly those who aren’t digesting their sugars well and have a secondary lactose intolerance – are also at risk of getting contact dermatitis.

“These babies produce acidic stools that burn, predominantly around the anus, and this is another cause of nappy rash,” he says, adding that to prevent and treat contact dermatitis caused by either urine or a stool, applying a zinc-based barrier cream (at every nappy change) is the best way to go.

Eczema

In the same way that babies might develop eczema behind their knees, they could also get it in the creases of their thighs. “This is why some parents are brand specific and say that only certain types of nappies work for their baby,” explains Dr Sinclair.

“While this type of nappy rash is similar to contact dermatitis, it classifies more as eczema as it manifests in the skin creases and is atopic (which means that the area of reaction is not necessarily in contact with the allergen). In other words, your baby is allergic to something and in this instance it’s either the nappy, a detergent, the bum cream, or the wet wipes,” he warns.

How to: Identify a rash 

So if you don’t want to exacerbate your baby’s eczema, the right nappy, a gentle detergent, a simple barrier cream and no wet wipes are a must.

“Not only can the most hyper-allergenic, scent-free and alcohol-free wet wipes trigger eczema but often, I’ve treated babies who blister as a result of wet wipes. They irritate a baby’s skin and I highly recommend Rooibos tea on cottonwool rounds instead. It’s alkaline and thus neutralises any acidity too.

“If your baby has true eczema, you’ll need to treat it with short courses of cortisone,” says Dr Sinclair.

Thrush

Finally, a red, spotty, angry-looking nappy rash spells thrush. This is caused by a yeast infection where the mucous membranes can sometimes become infected by the fungus candida albicans. “I don’t believe that a baby can get thrush without a red anus, because the thrush comes from the gut.

It starts with a little red ring around the anus, and then the spots follow. With boys, it’s always important to lift up their scrotum to check for it. Also, it’s important to lift up their penis because that’s where they get thrush – at the base,” explains Dr Sinclair. Use anti-fungal treatments and creams, recommended by your doctor, to treat thrush.

Also read: Is it thrush?

When to go to the doctor

“If you’ve been to the pharmacy, used a cream, and there’s still no improvement, then it’s time to go to the doctor,” says Dr Sinclair, adding that the term “nappy rash” should, in fact, be done away with completely. “Nappy rash is not a diagnosis and your doctor needs to get to the bottom of the problem.”

Be careful, too, of nappy rash creams that contain a bit of zinc, a bit of cortisone and a bit of anti-fungal agent, he cautions, because “no matter how well these creams work, they are cortisonebased and the genitals are like the face: you can’t apply cortisone regularly here as it thins the skin.

There’s also a strange condition known as histiocytosis X which, while very rare, includes an excoriating nappy rash that doesn’t respond to any treatment. Bear it in mind if faced with a ‘nappy rash’ that simply won’t go away.”

Nappy rash and antibiotics

Antibiotics often trigger diarrhoea, which causes two kinds of nappy rash – contact dermatitis from the stool and secondary thrush from the gut. The result is not pretty and you’re usually left with a very unhappy baby.

“Antibiotics kill 80 percent of the healthy bugs in your baby’s gut, which leaves the fungus with no competition , so it grows freely, resulting in thrush. A child with recurrent thrush who is on antibiotics should be on an anti-fungal too,” maintains paediatrician Dr Sinclair.

He goes on to explain that while there isn’t hard evidence that probiotics reduce thrush and nappy rashes, lots of parents use them as they’ve been shown to reduce the severity of antibiotic-induced diarrhoea. “Some parents even use a topical roll-on probiotic cream in the nappy area,” he says.

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