Irritant nappy rash, everything you need to know

Irritant nappy rash is a general term used to describe an irritant and inflammatory reaction on the skin of the nappy area. It is one of the most common skin disorders in infancy. That is why the midwives at Happymami have created this post about irritant nappy rash: everything you need to know.

Irritant nappy rash: everything you need to know

Irritant nappy rash affects around 7 to 35% of babies. It starts between 3 and 12 weeks of life, with a peak in cases between 9 and 12 months of age. It is usually associated with one or more factors: urine, stools, moisture or friction.

What causes it?

It is an irritant and inflammatory process secondary to the effect of moisture, the lack of aeration and the friction caused by the direct action of nappies; on top of that, there is the effect of stools, urine and other components of the nappy that can damage the area. The action of the nappy causes overhydration and maceration of the stratum corneum of the skin, which makes it more sensitive because the lower layers are left exposed to external irritants

How does it show itself?

This nappy irritation starts with a slight reddening or erythema of the area (bright red patches) with the possible later appearance of papules (small spots on the skin), superficial erosions, raised nodules and even pseudo-verrucous lesions if the process worsens and becomes chronic. When there is an improvement, residual hypochromic areas may remain (small patches on the skin with less colour).

Your baby may also show crying and irritability when being cleaned, in addition to the lesion in the nappy area. This discomfort can be noticeable if there is intense inflammation, and can even lead to urinary retention. It is not accompanied by fever, unless there is a superinfection with systemic involvement (generalised infection).

How long does it take to heal?

• Uncomplicated dermatitis usually heals within a few days.
• Dermatitis superinfected by candida usually takes longer, between 10 and 15 days.
• Dermatitis with a bacterial infection usually clears up in 7-10 days

How can it be prevented?

The best strategy you can have to prevent irritant nappy rash is to look after the skin in the nappy area. To do so, the two essential elements for prevention are good hygiene of the area, good practice in relation to the nappy itself and, if necessary, the application of protective products on the skin.

Skin hygiene

Bath

When bathing your baby, you should pay special attention to cleaning the face, the neck, the skin folds and the nappy area. Recommendations on how often to bath babies can vary widely between regions and countries depending on the culture of each place. Remember that more than 2 baths a day can dry out the skin and predispose to irritant nappy rash.

The bath should be short, no longer than 5-10 minutes, and with lukewarm water close to body temperature (37-37.5 °C). Overuse of soaps and excessive temperature, frequency or duration of baths or showers encourage the appearance of dry skin or irritant dermatitis.

Nappy area

You should clean the area properly, and it should stay clean and dry. You should dry the skin gently (e.g. with a soft towel), avoiding excessive friction. It is also advisable to use liquid products, without detergents or perfumes and with a neutral or slightly acidic pH, as they have the advantage of not altering the skin's acid mantle and allow it to keep its antimicrobial properties. An alternative when you cannot use warm water is baby wipes without perfume and without alcohol, which are also gentle and minimise friction.

Nappies

The determining factors for the appearance of irritant nappy rash are the type of nappies used and how often the nappy is changed.

• Type of nappy
  
  Disposable nappies are associated with a reduction in the incidence and severity of irritant nappy rash when compared with cloth nappies. The main reason is that disposable nappies keep the skin drier and with more physiological pH values. The innovations and improvements introduced in nappies in recent years have reduced the prevalence of irritant nappy rash. Therefore, the use of high-quality, highly absorbent nappies is recommended, made with superabsorbent polymers in gel form, placed in the core of the nappy, which hold fluids and keep the skin dry. Another advantage they offer is that they are made with breathable materials in their outer layer, which improves the microclimatic conditions. On the other hand, you should bear in mind the importance of using the right size (avoid nappies that are too tight), as well as choosing the type of nappy that best suits the anatomy of your baby, which is why sometimes it will be necessary to change brand.
• Nappy change frequency: a fundamental element in the prevention of irritant nappy rash is the number of nappy changes per day. You should change nappies frequently to reduce your baby's exposure to irritants; therefore, it is advisable to change the nappy immediately after your baby has a bowel movement or passes urine. It is proven that the incidence and severity of irritant nappy rash decrease when nappies are changed more than 8 times a day, regardless of the type of nappy. You may find it useful to leave your baby without nappies for a while during repeated episodes of irritant nappy rash, leaving the skin exposed to the air if possible.

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Protective products and the barrier effect

For the management of irritant nappy rash, using barrier-effect ointments will be very helpful. It is important to remember that 50% of cases in the first year of life are considered mild and the measures described above should be enough. If that is not the case, you can use creams known as "barrier" creams. These creams adhere to the skin, preventing contact with moisture. On the market you can find many brands, and the difference between them is their degree of consistency, or their zinc content. The higher the zinc content, the greater the effect on inflammation. The thicker the cream, the greater its barrier effect (for diarrhoea, for example).

When should you consult the paediatrician?

AEPED informs us that you should consult a doctor when, with the previous measures, after three days there is no improvement in the irritation or it gets worse, so that the paediatrician can rule out an infection by candida, a bacterium or sometimes a virus.

Conclusion: irritant nappy rash, everything you need to know

Remember that every case is unique, and that the best recommendation is prevention. Regular nappy changes will reduce the risk of suffering from irritant nappy rash. At Happymami, we know that motherhood is not always easy, you are doing great… Give yourself time, and after reading this post you will surely manage to improve your baby's irritation.