How do I treat diaper rash?

Dear Doctor,

All the diapers I use for my new-born seem to give her a rash. I’ve used almost every brand worth trying but they all leave her with a rash. Is there something I can use to help?

Lynette
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Dear Lynette,

Diaper rash is a common troublesome problem in babies. It occurs due to irritation of the skin around the anus and genital parts due to dampness. Mostly, the skin becomes inflamed and sore; causing pain and discomfort to the baby, whenever the nappy/diaper touches the skin or somebody touches that part. In some babies, the rash may spread higher up till the stomach. Some babies may also develop blisters.

The most common cause for the nappy rash is dampness. Though urine does not come out and soil the other clothes worn by the baby, it does make the nappy wet. Usually, urine is sterile unless there is some infection. But dampness can give rise to secondary bacterial infection of the pelvic part or urinary tract, causing more discomfort, and at times, fever. There is also increased risk of fungal infections due to the presence of moisture. This makes the affected part itchy. The fungal infection can also spread around till the thighs or higher up in the stomach.  A rash may also occur due to allergy to soap or lotion used over that part. Perfumed wipes or baby towels can also induce allergy.

Nylon diapers and underpants aggravate the risk for a nappy rash. For prevention, change the nappies frequently to avoid dampness prevailing over the pelvic parts.  Use only soft cotton diapers for the baby and avoid nylon underpants. Avoid scented wipes or those containing alcohol to clean the baby’s bottom, as rash may occur or be aggravated due to allergy to the perfume present in the wipe, or due to irritation caused by alcohol. Choose a soap or lotion for the baby with a neutral pH to avoid any allergy.

A barrier cream or lotion, like the one containing zinc or cod liver oil, can be used over the bottom, before putting on the diaper.

Regarding washing of non-disposable nappies, tumble drying is better than drying in hot sun to prevent them becoming hard.

If the rash improves with these measures, it is fine; otherwise it is advisable to consult a paediatrician.   
                         
Dr. Rachna Pande is a specialist in internal medicine. 

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