Napkin dermatitis (nappy rash, napkin eczema)

What is napkin dermatitis?

Napkin dermatitis refers to inflammation of the skin around an infant’s bottom caused by irritation from urine and faeces. It is very common.

What does napkin dermatitis look and feel like?

The skin under the nappy may appear red and raw, or sometimes dry or scaly. Usually the skin in the creases will be spared. Spots or blisters may also be present. It is likely to feel sore or itchy for the infant.

What causes napkin dermatitis?

The main cause is skin irritation from contact with urine and faeces, particularly if prolonged. Rubbing or chafing from nappies can contribute to the irritation, as well as the use of baby wipes and soap/detergent. The inflamed skin can become infected with bacteria and/or fungus (“thrush”).

Things you can do to help

There are several things you can do at home to help prevent and manage napkin dermatitis:

• Clean and dry the nappy area as soon as possible after wetting or soiling, changing the nappy at least every 3-4 hours
  
• Use high-absorbency nappies (e.g. disposable nappies with a gel matrix) that are the correct fit for the infant
• If using reusable cloth nappies, use a dry nappy liner and change frequently
• Use water, or fragrance-free and alcohol-free baby wipes and pat dry gently (avoid vigorous rubbing)
• Try and leave nappies off for as long as possible when practical
• Bathe your infant once daily (not more often) in water only; avoid the use of soaps, bubble baths, antiseptics, lotions, and talcum powder which can irritate
• Apply a thin layer of barrier cream/ointment at each nappy change - see your pharmacist for advice on available preparations (which include ointments containing zinc and castor oil, white soft paraffin, and brands such as Metanium and Bepanthen)

Make an appointment at your GP surgery

If the above measures do not improve things, the rash spreads, the infant appears very uncomfortable or is unwell, make an appointment at your GP surgery.

You may be prescribed a steroid cream or antifungal cream (or a combination of both). Occasionally, a course of antibiotics may be required. Your GP/nurse may also take swabs from the skin.

Referral to a specialist

If all the above measures fail to improve the napkin dermatitis, the infant may be referred to see a specialist to review the diagnosis and consider alternative treatments. The specialist may be either a Dermatologist or a GPwER in Dermatology (a GP who has also been trained in relevant areas of dermatology).

Helping with other skin conditions

If you, a family member, or friend have an undiagnosed skin condition; or you want to learn more about how to treat skin conditions, please view our short video on how to get the best from this website.