What to do for Nappy Rash ?

Nappy rash is a condition that occurs when the baby is exposed to wet and dirty nappies for a prolonged period. This is medically termed as the dermatitis of the nappy area. Though the urine does not contain any germs (that is why urine is called sterile), the dirt and microorganisms that are present on the baby’s body and the diapers react with the chemicals present in the urine and produces compounds like ammonia that causes skin irritation and hence produces rash. This is fairly common almost all the babies get it at some point. A survey has shown that about 65% of infants below 20 months have developed nappy rash. It is not a disease but just a skin irritation 

Nevertheless, just exposing the infant to wet nappies for a long time is not the only cause for nappy rash. It has been seen that some babies contract rash in spite of being cleaned and changed in regular intervals while some don’t develop these even when they are kept in wet nappies for a long time. This is because some babies have extremely sensitive skin and thus break out into rashes at any given point of time. 

Some on the other hand may have viral infections which worsens such condition while others get nappy rashes when they have cold or any other viral illness. Nappy rashes can be usually treated at home with a hundred percent success rate. But, if the rashes don’t disappear even after medication or worsen and hurt your baby, it is advisable to consult the pediatrician immediately.

 

 


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Signs and symptoms
The various signs of nappy rash are:
Inflammation of the skin – the skin around the genital area and anal region becomes red.
Blisters – blisters may appear which eventually peels off leaving purple patches on the body.
Spreading out – in many cases the rashes spread over the tummy and the back portion.
Appearance of ulcers – small ulcers can occur at the vicinity of the rash.
The rash causes great discomfort to the child. Due to the painful skin condition, the baby becomes restless, especially when they piddle as the affected area comes in contact with the urine. Many babies refuse to sleep in such a condition.

How to differentiate between nappy rash and other rashes?

• Color of the rash – an ordinary rash will be red and not bright red as that of a nappy rash. The baby is usually physically fine and only shows the feeling of discomfort when he/she gets wet. The rash also disappears once the baby’s bottom is exposed to fresh air, nappies are changed regularly and lots of zinc based creams are used.


• Fungal infection is very bright red – if the rashes appear in the folds of the skin, it is very likely that the baby is suffering from a fungal infection. This is a painful condition and baby gets very cranky and upset when nappies are being changed. Zinc based creams and airing the bottom are the regular advices, but it is suggested that professional help should be sought if the redness persists.


• Bright red, swollen and very warm rash – when the rash reaches this stage, it is most probably caused by a bacterial infection. This state can also induce fever. If so, the doctor must be consulted immediately.

How to prevent nappy rash in babies?
• Try to keep the area dry – The nappy area must be kept clean and dry. Nappies must be changed frequently and the child should not be given excess of fluid to avoid inordinate urination.
• Expose nappy area to fresh air – For some time during the day, allow the baby’s bottom to receive some fresh air. This will dry the area and also kill any harmful bacteria or fungi that are present. Put the baby on a water proof sheet but ensure that she is warm to prevent catching a cold.

• Avoid using products that might cause irritations – Adult soaps might have a beautiful fragrance but might cause irritation in your baby’s skin. Refrain from using adult soaps. Ask the doctor to recommend some good baby soaps which are mild and suitable for the soft skin. If the child has passed motion, immediately clean her skin using the mild soap and warm water; ensure that you pat her dry after that as moist skin might produce rashes.
• Switch your diaper brand – It is also possible that the diapers you are using are not suiting your baby’s skin. Try to switch over to a different brand. If you are using cloth diapers make a shift to disposables to see the difference.
• Protecting the baby’s skin – In some cases, doctors suggest the use of some ointment that is usually spread over the baby’s bottom after changing of the nappies. This cream prevents the urine from coming in contact with the skin and thus reduces the chances of nappy rash. Boric acid is not recommended as it is a toxic substance. Baby talcum powders can be used to absorb the moisture and keep the baby dry. Do not use adult talc as they may contain asbestos which are harmful for the baby skin.

 

Medications used for treating nappy rash
If the rash persists for a few days in spite of the application of zinc oxide creams, the doctor can prescribe drugs based on the kind of rash. List of few common drugs are given below:
• Seborrhoeic Dermatitis – This is a steroid cream but is not meant for long term use.
• Impetigo – This is an antibiotic which can be given orally to the baby.
• Intertrigo – This is a hydrocortisone cream and also a protective ointment.
• Candida – This is a common topical anti-fungal ointment.

The possible triggers
• Ammonia – this is the most common trigger. When the chemicals present in the urine react with the other chemicals in the body, it gets converted into ammonia. This causes the “sting” in the baby’s skin.
• Thrush or Candida – thrush is present in the faeces or stool. At times the level of Candida increases due to the intake of antibiotics. This thrush exacerbates the rash and makes it extremely painful. 
• Chemicals – when cloth nappies are washed in soaps, detergents and fabric softeners, the chemicals present in those can cause irritation and hence produce rashes. Wet baby wipes containing alcohol can also cause severe irritation; even certain baby products like baby soaps and moisturizers are responsible in causing rashes if the baby has extremely sensitive skin.
• Rough nappies – if the nappies are not made of very soft fabric they can rub and wound the infant’s skin. Also plastic nappies though cleaner than the normal ones, are not recommended. Plastic diapers prevent the flow of air and hence the moisture sets on the skin causing inflammation and redness.

Who can help?
• The pediatrician.
• The maternal and Child Care nurse.Medications used for treating nappy rash.
If the rash persists for a few days in spite of the application of zinc oxide creams, the doctor can prescribe drugs based on the kind of rash. List of few common drugs are given below:
• Seborrhoeic Dermatitis – This is a steroid cream but is not meant for long term use.
• Impetigo – This is an antibiotic which can be given orally to the baby.
• Intertrigo – This is a hydrocortisone cream and also a protective ointment.
• Candida – This is a common topical anti-fungal ointment.
 

Who can help?
• The pediatrician.
• The maternal and Child Care nurse.

 

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Article Contributed By: Sukanya Banerjee
 

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