Diaper rash is a common condition affecting millions of babies worldwide. However, most rashes are mild and can be safely treated at home without medical interventions.

A physician or a paediatrician (specialist in childhood diseases) needs to be contacted if the rash gets progressively worse, becomes infected or there are other warning signals like fever, refusal to feed, diarrhoea, excessive vomiting etc.

Diagnosis of diaper rash

The diagnosis of diaper rash is usually made by the clinical appearance of the rash. The physician examines the baby and other parts of his or her body to detect if there is presence of the rash elsewhere. If the rash occurs elsewhere, it may be indicate that the rash is caused by an underlying condition or is a symptom of another problem.

When to contact the doctor about diaper rash

A severe nappy rash that refuses to go away with treatment may need the intervention and referral to a dermatologist who specializes in skin disorders. The cause may be then definitely identified and treated. Those with frequent occurrences of nappy rash also need to be seen by a dermatologist.

Complications of diaper rash

Complications of nappy rash that need attention include secondary bacterial infections. This is apparent by an irritated and red skin, pus filled lesions and damaged tissues.

Treatment of mild nappy rash

Mild nappy rash usually requires no medication for treatment. The baby should be managed at home with simple skin care routines:

• The baby should be kept out of the nappy for as long as possible. The baby’s nappy area thus remains dry and gets fresh air.

• To avoid prolonged contact with urine and faeces the baby should be placed over a towel or a dry sheet that is changed as soon as it is wet or soiled. The best idea is to keep the baby off his or her nappy while asleep.

• Soaps should be avoided. The baby’s nappy area should be washed with water and completely dried before putting on a new nappy. A soft material made of cotton wool or a soft towel should be used to pat the area dry. There should be not friction or rubbing over the affected area.

• Barrier nappy rash ointments are available over the counter at pharmacies. These may be applied in a thin layer after the skin is dry. Care should be taken not to apply a thick layer that robs the skin of its breathability. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams.

Treatment of severe nappy rash

Severe nappy rash usually needs medical attention:

• Steroid creams and ointments are prescribed. These reduce inflammation of the skin and relieve any itching and redness. These may be needed to be applied once a day after cleaning and drying the skin. Usually these creams are not prescribed for more than seven days in a row.

• Antifungal creams – Common antifungal and anticandidial medications include:

  • Clotrimazole

  • Econazole

  • Ketoconazole

  • Miconazole

  • Sulconazole

  • Nystatin

These may need to be applied over the nappy area twice or thrice a day. These need to be used for 7 to 10 days after the rash has healed. This ensures that the infection is completely treated.

Antibiotic creams and ointments need to be applied in cases of secondary bacterial infections. Some babies with severe infections may also need oral antibiotic syrups or liquids. Good antibiotic option is mupirocin. (1-6)