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What is nappy rash?

Nappy rash is inflammation and irritation of the skin around the buttocks, genitals and perianal area. It may spread as far as the inner thighs and the waistline. Most babies will develop a mild form of nappy rash at some stage, but generally a few days of home treatment is all that is needed to clear it. In severe cases the baby may show signs of discomfort and distress, and if the rash persists with no improvement, medical attention may be necessary. Fortunately this is very rare.

Why do babies get nappy rash?

Babies are prone to nappy rash due to the fact that their skin barrier is not yet fully formed. The skin structure is still developing and the layers of epidermis are thinner, making it more permeable to water. A healthy skin barrier is largely dependent on good bacteria (microbes) living on the surface of the skin and in babies, the microbiome (microbial population) is not fully formed and stable. A course of antibiotics can negatively affect this natural skin microbiome and nappy rash often presents following antibiotic treatment.

Constantly being in nappies causes a skin blockage which can contribute to nappy rash. Inflammation can also be caused by the ongoing exposure of the skin in the nappy area to faeces and urine. The inflammation may be a result of a number of factors, including the digestive enzymes in the faeces, bile salts, and contact with microbes from the gut, all of which affect the balance of resident microbes on the skin. Urine has a high pH and prolonged exposure of the skin to alkaline urine alters the balance of natural skin microbes and increases the permeability of the skin. This weakens it and makes it more susceptible to irritation.

What is the best treatment of nappy rash?

One of the most effective ways to prevent and treat nappy rash is to let the skin “breathe” by leaving the nappy off for prolonged periods and allowing the skin to be exposed to the air. Although barrier creams are good at preventing contact of the skin with faeces and urine, they can often exasperate the breathability issue because they contain ingredients, which form a total barrier. Instead, treat the skin barrier of the affected skin with a bum cream that contains natural plant oils (rather than petroleum bases), which allow the skin to breathe, supports a healthy microbiome and has a pH which matches the natural pH of skin.

It is also vital that you avoid using wipes which contain synthetic fragrances and other chemicals as these will all exasperate the existing inflammation. Natural plant fibre wipes which use only organic and natural liquid infusions should be used. When washing your baby, make sure to use a mild natural baby wash which contains no harsh chemicals and fragrances, as these will further compromise the skin barrier and irritate the already inflamed skin. Look out for organically certified products as these are audited to ensure all nasty chemicals are banned. Applying topical probiotics to actively shift the skin microbiome population has also been shown to be very effective in improving the skin’s barrier function. For persistent nappy rash, it would also be advisable to consider a good gut probiotic supplement.

In summary, consider the following to assist in clearing and treating nappy rash:

  • leave the nappy off for prolonged periods to allow the skin to be exposed to the air
  • use natural based bum creams with organic ingredients
  • use natural plant fibre wipes with organic liquid infusions
  • be mindful of the skin’s microbiome and its importance for a healthy barrier – use natural washes which don’t disrupt this microbiome or cause other skin irritations
  • after washing make sure the baby’s bottom is properly dry
  • change the nappy often
  • do not use powder such as talcum powder
  • do not use tight-fitting plastic pants over nappies