As seen in the Nov/Dec issue of Retail Pharmacy Assistants e-magazine.
Nappy rash (sometimes called ‘diaper dermatitis’) is an extremely common – and irritating – problem.
It affects up to 25 per cent of nappy-wearing infants within the first four weeks of life and up to 100 per cent at some point in infancy1 with the highest prevalence at between nine and 12 months of age.2
Tani Paxton, Midwifery Adviser at the Australian College of Midwives, says nappy rash generally presents as “red and raw” skin in the nappy area and can also be spotty in appearance.
“It can be sore or itchy when the area is wiped,” she said. “Your baby may be unsettled or irritable.”
Causes
The most common cause of nappy rash in children is irritation.
“Constant moisture from urine and faeces and friction from materials (ie, nappies) cause damage to the skin,” Ms Paxton said.
“In some cases, the skin can be further irritated by bacteria, yeasts – for example, Candida or thrush – detergents or nappy wipes.”
There are no differences between boys, girls or ethnic groups3 and prevalence varies geographically, depending on cultural differences in the use of nappies, toilet training and skin care practices.4
Interestingly, breastfed infants have a lower stool pH than formula-fed infants, which may help to prevent nappy rash.5
Another factor that may influence nappy rash is nappy choice: an important factor to consider given the renewed popularity of cloth nappies.
“While cloth nappies are good for the environment, they don’t absorb moisture as well as disposable nappies,” Ms Paxton said. “Disposable nappies allow the moisture to be absorbed quickly, which helps keep the skin dry.”
Prevention
When it comes to nappy rash prevention, the key is to change baby’s nappy frequently, says Sudocrem Brand Manager Catherine Patsias.
“Removing a wet or soiled nappy so it’s not in contact with their skin is the single most useful thing you can do,” she said, also recommending:
- Cleaning baby’s skin thoroughly with warm water or gentle fragrance-free nappy wipes after removing their soiled nappy.
- Allowing their skin to dry well.
- Smearing a good quality barrier cream onto their skin to create a protective barrier between their skin and their wee and poo.
- Giving baby some nappy-free time each day.
Sudocrem is promoted as a 15.25 per cent zinc-based emollient cream that soothes and protects skin.
“Sudocrem has been an effective ally for over 20 years to assist in the management of nappy rash,” Ms Patsias said. “We’re proud to be Australia’s number one nappy rash cream.”6
Soothe and protect
No matter how diligent you are with your baby’s skin, nappy rashes can still occur. The good news is that mild nappy rashes can often go away with the use of a cream or spray that targets the issue.7
“To prevent and treat nappy rash, use topical treatments that contain the ingredient zinc oxide,” advises a spokesperson for baby brand Curash.
“Zinc oxide is the most active ingredient that helps to soothe and relieve skin inflammation/reduce skin irritation.”
Curash Nappy Rash Cream and Curash Anti Rash Baby Powder contain 20 per cent and 25 per cent zinc oxide respectively and are promoted as helping to soothe, heal and protect against nappy rash on baby’s delicate skin.
Amit Saha, Group Technical Manager at LaCorium Health, says promoting healing of the nappy rash is an important aspect of overall recovery, and careful consideration should be given to ingredients that can achieve this.
“Most of the market product uses petrolatum, dimethicone or zinc oxide as a barrier forming ingredient,” he said. “However, zinc oxide provides the best barrier in a nappy rash environment.
“Always pick a product for nappy rash that provides optimum balance between barrier and healing. Look for at least 15 per cent zinc oxide in the formula and five per cent panthenol, or a combination of both surely would be the best.”
Dermal Therapy’s Little Bodies Nappy Balm is a two-in-one specialised formula promoted as containing 15.4 per cent zinc oxide for skin protection and five per cent panthenol to soothe and repair.
Lucas’ Papaw Ointment is another popular option and is commonly used for post-natal application by parents for babies and mums alike.
The “clinically proven” ointment protects infants’ skin from prolonged periods of moisture, providing relief from the discomfort of nappy rash.
It also is said to soothe and relieve cracked nipples and stretch marks experienced by mums after birth.
Its range includes a 25g tube “perfect for nappy bags”, and 75g and 200g tubes “perfect for the changing table or medicine cabinet”.
Complications
It can take weeks for a child’s skin to repair itself after a bout of nappy rash. During this time, their skin may be more easily irritated.
They’re more likely to get other infections, such as thrush, during this time. Nappy rash also increases the risk of urinary tract infections and vaginal infections in girls.8
Ms Paxton says parents and carers should be advised to chat with their postnatal midwife and see their GP when nappy rash persists beyond mild irritation and is distressing despite over-the-counter treatment
References
- Ravanfar et al 2012, Burdall et al 2019
- Cohen, 2017
- Merrill, 2015
- National Institute for Health and Care Excellence [NICE] CKS, 2018
- Merrill, 2015
- IQVIA. ‘RMS/Sell Out Service’. Babycare & Accessories category, Australian Pharmacy. Total Value Sales and Units Sales, 52 weeks to W/E 2022-05-07
- curash.com.au/the-low-down-on-nappy-rash
- raisingchildren.net.au/newborns/health-daily-care/poos-wees-nappies/nappy-rash
This feature was originally published in the Nov/Dec issue of Retail Pharmacy Assistants e-magazine.
