What should you know about extremely bad nappy rash?

Wetness, stool, urine, friction and prolonged contact with a soiled nappy can inflame delicate skin. A rash that is bright red, raw or sore may be irritant dermatitis. Yeast can be involved when redness extends into skin folds or there are small spots around the main rash. Blisters, crusting, pus or sharply spreading redness suggest that a clinician should check for infection or another diagnosis.

The child’s age, recent antibiotics, diarrhoea, fever and how quickly the rash appeared all help guide care. Nappy rash can hurt, so crying during cleaning or nappy changes is useful information to share.

Change nappies promptly, rinse with lukewarm water or use fragrance-free wipes, and pat rather than rub. Let the area air-dry when possible, apply a protective barrier recommended for babies, and fasten nappies loosely. Avoid talc, perfumes, harsh soap and home remedies that sting broken skin.

If the rash is persistent, extensive or involves folds, arrange medical advice. Emollient therapy may support the skin barrier, while topical antifungal treatment is used only when a clinician considers yeast likely.

Contact a clinician promptly for fever, marked pain, blisters, open sores, pus, bleeding, rapidly spreading redness, or a child who seems unusually sleepy or unwell. Urgent help is needed if the child is difficult to wake, is feeding poorly, or has signs of dehydration such as very few wet nappies.

Ask whether the rash is irritant, yeast-related or another skin condition; which cleanser and barrier to use; whether treatment should reach the folds; and how soon improvement should be expected. Mention recent antibiotics, diarrhoea, fever and products used on the skin.