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Nappy Rash: What should we do?

by Dr. Shubhada Bichu
Published: Last Updated on 1 comment

Nappy Rash or Diaper rash or Diaper Dermatitis is an irritating rash that develops on the skin that is covered by a diaper.

It is one of the most common skin problems in infants and children.

Diaper rash occurs most commonly in infants between ages 9 and 12 months, but can occur at any time the child wears a diaper. Fortunately, most cases of diaper rash are short-lived and resolve with home treatment.


There are two main types of diaper rash: Rashes that are caused or worsened by a diaper and Rashes that are not related to diaper use.

Diaper-related rash — Usually caused either by irritation, a yeast/fungal infection, or an allergic reaction.

1.Irritation — caused by any irritant (usually urine or feces) is the most common cause of diaper rash.

 It is generally seen on the buttocks, lower abdomen, genitals, and upper thighs (the areas that are in direct contact with the diaper). Skin folds (groin and area between buttocks) are not usually affected. Symptoms can vary from mild redness to painful areas of skin that are raised, peeling, or weeping.

Such Diaper-rashes may occur more frequently if a child has an episode of diarrhea or has recently taken antibiotics.

2.Candida infection — Yeast or Fungal (Candida) infections develop usually following episodes of loose motions (diarrhea).

Rashes caused by Yeast infections are often found in the skin folds between the thigh and body, and in the folds of skin around the genitals. These rashes often appear ‘Angry red’!

3.Allergic reaction — Allergic reactions or skin sensitivity to the diaper itself is a less common cause of diaper rash. This reaction could be to different materials, dyes, gels or other chemicals used to make that diaper.

Non-diaper-related Nappy rash — Skin conditions that can affect the diaper area but are not caused by the diaper include seborrheic dermatitis, bacterial infections, psoriasis and others. This article limits the discussion to rashes that are caused or worsened by a diaper.


Prevention of diaper rash includes a combination of measures, which are most effective when used together. The letters ABC are a useful way to remember these measures:

A = Air out the skin by allowing the child to go diaper-free

Leave the nappy off as much as possible

This allows fresh air to get to the skin. Let the baby lie without a nappy on a towel or disposable absorbent sheet for a period of time each day. However, do change the towel or sheet as soon as it becomes wet.

B = barrier; use a paste or ointment to protect the skin

Nappy creams literally form a barrier between your baby’s skin and the poo or urine. These creams contain zinc oxide , white soft paraffin etc and are available in pharmacies. Ideally, rub on a thin layer of barrier cream or ointment just before putting on each nappy.

Powders — Powders that contain talc or corn starch can reduce friction and moisture. However, powders are not generally recommended because the child could accidentally inhale them.

C = clean; keep the skin clean

Change the nappy often.

A suggested interval might be every two to three hours . Ideally, change the nappy as soon as it is wet or soiled. The aim is to prevent skin being in contact with urine and poo for long periods of time.

Clean the skin in the diaper area gently and carefully. Overzealous cleansing can cause or worsen irritation and delay skin healing. Gentle cleansing with warm water and a soft cloth or cotton-ball is usually sufficient. If soap is desired, a mild, fragrance-free product is recommended.

As far as possible, avoid use of baby wipes!

If baby wipes are used, choose a brand that is alcohol and fragrance-free. Baby wipes are not recommended if the skin becomes irritated or develops open sores. If a diaper rash does not seem to be improving, baby wipes should potentially be stopped, as some baby wipes can cause allergic skin reactions.

After washing, make sure the baby’s bottom is properly dry. Do this before putting on a new nappy. Dry by patting, not by rubbing, with a towel. Also avoid soaps, bubble baths and lotions. Don’t use tight-fitting plastic pants over nappies.

If an infant or child with diaper rash does not improve after a few days or if the child develops excessive redness, blisters or pus-filled sores, the parent should contact the child’s health care provider.

Treatment of different Types of Diaper Rashes

Steroid creams — If the child’s skin becomes severely inflamed, the health care provider may recommend a mild, over-the-counter steroid cream such as 1% hydrocortisone. This can be applied in a thin layer to the irritated skin twice per day for no more than 5 days. Remember steroid creams should be used only on the advice of your treating doctor

Antifungal treatments — An antifungal treatment may be prescribed if the child is diagnosed with a yeast/candidal infection. Antifungal treatments are available as a cream, ointment, or powder. The treatment is usually applied two or three times per day and can be applied beneath a barrier skin ointment or paste, until the rash is gone.

Antibiotics — Sometimes the inflamed skin of a nappy rash becomes infected with other types of germs (bacteria). This may be suspected if the rash becomes worse, despite use of the above treatments. If the child develops signs or symptoms of a skin infection, a health care provider should evaluate the child. If needed, he or she may prescribe an antibiotic ointment or oral antibiotic. Over-the-counter antibiotic creams or ointments (sample brand names: Neosporin, Bacitracin) are not recommended because they contain ingredients such as neomycin and bacitracin, to which many children are allergic.

Click for an informative video on Nappy Rash Prevention.

1 comment

Sridhar November 30, 2020 - 11:47 am

Very well written article, very helpful


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