Nappy rash can be very difficult to cope with. It is very common, and there are many different factors involved. Most babies will get nappy rash if their nappies are not changed often enough because of the irritant effect of urine and faeces on the skin. Similarly, most babies will get nappy rash if they have diarrhoea for any reason. However, even when nappies are changed very frequently and a baby has a normal bowel habit, nappy rash may occur.
Some babies just seem to be particularly sensitive to the irritant effects of urine and faeces. Some babies may have an underlying problem with eczema, which means their skin is already inflamed and vulnerable to infection. Seborrhoeic dermatitis is another condition that causes redness and scaling in the nappy region, as well as on the scalp, face and behind the ears. This condition tends not to be itchy, but otherwise is very similar to ordinary nappy rash.
Once a baby’s nappy area is inflamed, it is very vulnerable to infection either with fungus, e.g. candida (which causes thrush) or with bacteria. Candida tends to cause a bright red rash that goes right into the creases (whereas ordinary nappy rash tends to spare the creases) and spotty scattered areas around the edge of the rash. Bacterial infection tends to cause a similar red rash, which may spread away from the nappy area and be associated with some swelling. Bacterial infection requires either antibacterial cream if it is mild, or antibiotic medicine if it is more severe. When a baby has bad nappy rash, keeping the nappy off whenever possible is very effective because the longer the area is cool and dry, the more likely it is to be able to heal. Candida especially thrives in a hot, moist environment.
There are a whole gamut of treatments for nappy rash including emollients, barrier creams, steroid creams, anti-fungal creams (Canesten) and combination creams (steroid and anti-fungal combined). Anyone who is getting repeated fungal infections should be checked for diabetes. Another thought is that although modern disposable nappies are effective at keeping a baby’s bottom much drier than it would be with terry nappies, some babies do react to a particular type of nappy, presumably to one of the products used within it. It might be worth trying a different brand if you have not already done this.
Unfortunately, there is no easy solution.