Tuesday 19 February 2019

Dear Dr Nina: Nappy rash ... how can I help my daughter heal better?

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Q My daughter has had a terrible nappy rash for about three days now. The skin isn't broken but it so red and angry and she screams in pain when I try to change her nappy. She has had a bit of a tummy bug all week and does regular dirty nappies. What can I do to help her heal better?

Dr Nina replies: Intertrigo is an infection occurring in skin folds due to skin-on-skin friction. It is very common and can be found in any natural or obesity-created skin folds. The moisture in skin folds where air can't circulate facilitates the infection.

Nappy rash is a form of intertrigo. This rash is thought to occur in up to one third of babies and occurs most commonly in those between nine and 12 months of age. Intertrigo of the groin is more common in those who are obese, have urinary or faecal incontinence, or in cases of poor hygiene. All forms of intertrigo are more common in those who are obese, diabetic or who are exposed to humid conditions.

Moist, damaged skin acts as a breeding ground for all kinds of microorganisms. Thus babies wearing nappies are most at risk. Urine and faeces, if left, may release ammonia, which will irritate sensitive baby skin. Infections may be due to yeasts, fungi, bacteria or all three. Initially, the skin will appear red and inflamed. In more advanced cases, the skin may peel or scale and may appear wet. Infection may cause weeping and oozing and there may be a foul smell.

Your baby may be more irritated than usual and upset when you try to cleanse the skin. Your doctor will normally diagnose this condition purely by its appearance. In more serious cases, a skin swab or scraping will try and identify the underlying organism growing.

To avoid nappy rash, keep the area cool and dry and avoid friction. Use a highly-absorbent nappy and change this very frequently. Use a barrier cream at every nappy change. Cleanse skin regularly but use water or gentle products suitable for eczema on irritated skin. Some baby wipes can have high levels of perfume and irritants and this may cause pain and make skin worse.

Once your baby has nappy rash, it's especially important to do all of the above. If possible allow your baby to lie on a towel or mat with the nappy off to enable the skin to stay cool and dry for a more prolonged period.

This may be difficult if your child has a stomach bug and is having loose and nasty nappies but always aim for dry, cool skin.

Other treatment will depend on the cause. A good place to start is with an over-the-counter cream which combats candida or fungus, as these are commonly present.

If theses don't help, your GP may prescribe other anti-infective creams; those containing gentle steroids can help reduce inflammation in the nappy area. This should only be used for short periods of time. Most cases of nappy rash will settle with simple measures and over-the-counter creams. Talk to your pharmacist to get some advice. Failing that, a trip to the doctor may be the help you need.

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