Health Tips

Nappy/diaper rash, clinically known as infantile eczema, is a common form of skin inflammation found on a baby’s bottom i.e. the diaper’s area. Up to a third of babies and toddlers in diapers have diaper rash at any one time. It doesn't usually develop in newborns, but all babies can get it.

Image credit from: https://dermnetnz.org/topics/napkin-dermatitis-images/

Image credit from: https://dermnetnz.org/topics/napkin-dermatitis-images/

How It Happens

The following may increase your baby’s likelihood of developing diaper rash:

• Having frequent stools or diarrhea

• Diaper areas are not being kept clean and dry

• Wearing too-tight diapers that rub the skin

• Teething, which causes extra saliva to be passed through the gut

• Having had thrush (a yeast infection) in the mouth

• Taking antibiotics (or if you're breastfeeding and on antibiotics, they can pass through your breast milk to your baby). This is because antibiotics can kill both bad and good bacteria. The antibiotics may deplete the bacteria in the baby’s body that keep the yeast in check, which leads to yeast skin infection. Antibiotics may also cause the baby to have diarrhoea more frequently.

The majority of diaper rash cases are classified as irritant eczema, whereby constant friction between the skin and diapers, as well as prolonged contact with urine and stools that lead to skin rashes. 

In less common instances, your baby may develop diaper rash as a result of allergic reaction to specific chemicals in the diapers, creams, ointments and baby wipes. Diaper rash is often confused with skin infections caused by bacteria or yeast. More on that later.

Managing nappy rash: A,B,C,D,E

With a simple plan that goes with the acronym ABCDE, you may be able to manage your baby’s diaper rash easily:

A: Air out skin

Leave the baby some time out of their diaper. This practice may allow better airflow and prevent skin overhydration, thus reducing the risk of skin infections. To avoid messy accidents, try laying your baby on a large towel and engage in some playtime while he or she is bare-bottomed.

B: Barrier ointments

Use a barrier ointment such as petroleum jelly, or any over-the-counter product that contains zinc oxide, petrolatum, cod liver oil, dimethicone, lanolin, dexpanthenol, or Burow solution on your baby’s diaper area before putting on new diaper. This helps to lock in skin’s moisture, thus preventing skin irritation and preserving a healthy skin barrier.

C: Clean skin

Change your baby’s wet diaper frequently, and bath your baby daily – but avoid bathing them more than twice a day as that may dry out their skin.

D: Disposable diapers

If you're using cloth diapers, consider using breathable disposable diapers while the rash heals. If you must use cloth diapers, be sure to wash them with a gentle soap that won't irritate your baby's skin. Never use dryer sheets or fabric softeners because the chemicals and fragrances in these can make any existing rash worse or cause a new one.

E: Educate yourself on diaper rash prevention

Here’s how you can prevent diaper rash in your baby:

• Don’t over tighten diapers as it sets up a moist environment that favours diaper rashes.

• After bathing your baby, gently pat the skin with a clean towel or let it air dry.

• Consider using ointment more regularly.

If the nappy rash is causing discomfort to your baby, you may purchase nappy rash cream at any pharmacies. Below are some of the common nappy rash products available in the market. You are encouraged to consult a pharmacist for suitable product selection.

Image credit: https://www.babydash.com.my/sudocrem-nappy-rash-cream-60g.html

Image credit: https://www.alpropharmacy.com/oneclick/product/pureen-nappy-rash-cream-50g-exp-date-07-2022/ 

You should apply the cream on the baby’s diaper area first and wait a few minutes before you apply the barrier ointment. 

Nappy rash usually resolves within 3 days. However, if the rash doesn't go away or your baby develops a persistent bright red, moist rash with white or red pimples that spreads into the folds of their skin, they may have an infection.

When nappy rash becomes a skin infection

Take your baby to see a healthcare provider if:

• Rashes like these showed up:

Image credit: https://dermnetnz.org/topics/napkin-dermatitis/

This is known as satellite papules, which is caused by yeast infection (Candida sp.) . If you are unsure if the diaper rash in your baby is caused by yeast, take them to see a GP.

• The rash spreads to your baby's abdomen, back, arms, or face.

• You notice signs of infection such as lesions, blisters, or large sores that are filled with pus.

References:

1. https://www.nhs.uk/conditions/pregnancy-and-baby/nappy-rash/

2. https://www.mayoclinic.org/diseases-conditions/diaper-rash/symptoms-causes/syc-20371636

3. https://www.verywellfamily.com/what-are-the-symptoms-of-a-yeast-diaper-rash-284384

4. https://onlinelibrary.wiley.com/doi/full/10.1111/pde.14047

Written by

Ms Joyce Toh