What should you know about worst nappy rash?

Nappy rash develops when moisture, friction and contact with urine or stool irritate delicate skin. Severe irritation may look bright red, shiny, raw or cracked, and a baby may cry during cleaning or nappy changes. Small spots around the edge, involvement of skin folds or satellite patches can suggest yeast rather than simple irritation.

Other causes include eczema, contact reaction or bacterial infection. Blisters, pus, crusting, spreading redness or fever are reasons to have the baby assessed rather than changing products repeatedly.

Change wet or soiled nappies promptly, rinse with lukewarm water or use a gentle fragrance-free cleanser, and pat rather than rub. Let the skin dry before applying a protective barrier and use a slightly looser nappy when possible. Short periods without a nappy can reduce trapped moisture.

Avoid talcum powder, fragranced wipes and scrubbing. A clinician may recommend [Emollient Therapy](/treatments/medical-dermatology/emollient-therapy/) for the barrier or [Topical Antifungal Treatment](/treatments/medical-dermatology/topical-antifungal-therapy/) when yeast is suspected; use prescribed products as directed.

Arrange prompt medical review for fever, poor feeding, unusual sleepiness, blisters, open sores, pus, crusting, rapidly spreading redness or pain that makes changing difficult. Seek advice if the rash is not improving with careful skin protection, keeps returning, or extends outside the nappy region.

Ask whether the rash looks irritant, fungal, allergic or bacterial, which cleanser and barrier are suitable, and how long to use any medicated cream. Mention recent antibiotics, diarrhoea, new wipes, soaps or nappies.