Nappy
rash is a red skin rash that appears in the napkin area of babies.
It is less common than it was because of the use of disposable
nappies. The skin rash is usually a reaction to one of two factors,
or both, the factors being the presence of ammonia which sets
up a chemical dermatitis (see Eczema/Dermatitis) or infection
with candida, the fungal organism that also causes vaginal thrush.
Ammonia is released when bacteria in the stool reacts with urine.
Therefore, the less frequently the nappies are changed, the
more likely is nappy rash to develop and severe nappy rash can
be a relative marker for poor child care - though not, by any
means, always, as many babies, impeccably looked after, also
get the condition. If the nappies are not disposable, they should
be very carefully cleaned, sterilised and rinsed so that none
of the chemicals used in the process remain in the nappy, themselves
to set up a chemical dermatitis. In the days of towelling nappies
a very large survey found that the simple expedient of putting
a teaspoonful of vinegar in the water in which the nappies were
soaked prevented a lot of nappy rash by providing a mildly acidic
environment in which candida was unable to flourish. Sometimes
nappy rash can be a symptom of other skin conditions such as
eczema and psoriasis, and can be more than usually difficult
to clear.
Disposable nappies are very satisfactory if changed with reasonable frequency. A child should be left wet and dirty for as short a time as possible. If nappy rash develops a useful ploy is to leave the child uncovered to the air in a suitably warm environment. Barrier creams may be used to protect the skin against ammonia and other irritants. Creams containing anti-fungals such as clotrimazole and nystatin are very useful in combating candida infection. Sometimes the nappy rash cream given by the nurse or doctor may contain an amount of a corticosteroid such as hydrocortisone 1% which will help to reduce the inflammation, but hydrocortisone by itself, should not be used in case it temporarily suppresses processes that are still continuing, such as fungal infection. |
