All content I provide must be used for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. Dr Sri is not responsible or liable for any diagnosis made by a user based on the content of this blog or my website. Dr Sri is not liable for the contents of any external internet sites listed, nor does it endorse any commercial product or service mentioned or advised on any of the sites. Please read my disclaimer and register as a user of this blog. Always consult your own doctor if you’re in any way concerned about your health.
Nappy rash not diagnosed and managed will soon result in a major crisis. Candida (fungus that cause nappy rash or thrush) is said to be now resistant to treatment. The infection is spreading all over the world and so become a common infection that can kill young babies and children. Please read and join discussion in my Facebook “Ask Maya“, You can also buy my book Maya Bring Tears Of Happiness or Maya Fighting Infections Saving Lives and download my App Dr Maya from GooglePlay or AppStores
Nappy Rash commonly affects infants, with peak incidence occurring when the individual is aged 9-12 months. One study determined that at any given time, nappy rash is prevalent in 7-35% of the infant population. Nappy rash can also affect persons of any age who wear nappy, in particular, elderly people.
Children with a previous medical history of eczema or atopy rash be more susceptible to nappy rash. Another factor to consider in a child’s medical history is the immune status; babies of HIV parents and some syndromes are associated.
Contact with urine and stool for longer duration: A soiled nappy has moisture and ammonia that comes from the urine and stool of your child. When such soiled nappy are not changed for a longer duration, the moisture and ammonia can affect the sensitive skin of your baby. The simplest way to avoid this is by minimizing the time your baby is wearing a soiled diaper.
Over hydration of the skin, maceration, prolonged contact with urine and stool, retained soaps, and topical preparations and is a prototypical example of irritant contact dermatitis.
The rash is usually confined to nappy covered area but can spread upwards or below groin. Wetness in the Nappy area make the skin more susceptible to damage by physical, chemical, and enzymatic mechanisms.
Wet skin increases the penetration of irritant substances such as urease, ammonia from bacteria living in the area. Urease has a mild irritant effect on skin. Lipases and proteases in feces mix with urine and cause an alkaline surface pH, adding to the irritation. (Feces in breastfed infants have a lower pH, and breastfed infants are less susceptible to Nappy Rash.) The bile salts in the stools enhance the activity of fecal enzymes, adding to the effect.
Candida albicans has been identified as another contributing factor to Nappy Rash; infection often occurs after 48-72 hours of active eruption. It is isolated from the perineal area in as many as 92% of children with nappy rash. Other microbial agents have been isolated and said to be secondary infections.
Soaps and Detergents: The soaps used for baby baths or the detergent used to wash cloth diapers can very easily create rashes if the chemicals in these soaps and detergent are harsh for the baby. Try switching the brands of these soaps and detergent and if they were the reason for causing rashes, the rashes will very easily stop occurring with this simple change in their brands.
Baby Wipes and Nappy Brands have some chemicals to better absorb the urine and stool and some fragrances to reduce the foul smell. These chemicals can affect the sensitive skin of your kid. Changing the brands of these nappy and baby wipes with some fragrance-free brands for a change and see if it works. Also, see that the nappies are not too tight for the kid – this will increase moister in the groin and help fungal grow.
The plastic in the nappy will increase temperature and moisture inside the diaper. Such conditions help the growth of microbes like many bacteria, which very easily feed on the urine and stool. So, take care that the diaper areas are kept cool and dry.
Sensitive Skin: Rashes are most likely to affect infants who have extra sensitive skin or who have skin problems like dermatitis or eczema.
Nutrition is also an important factor to consider. A biotin-poor diet, such as occurs with elemental formula alone, may result in perioral erythema, developmental delay, loss of hair, and hypo tony (in addition to Nappy Rash).
Lack of zinc-binding ligands in the intestine, seen in a congenital autosomal recessive disorder (hair loss, rash, and diarrhea). Generally, a decrease in zinc in the diet may be associated with relative alopecia and nappy rash. One study found the lowest levels of zinc in the hair of infants aged 8 months. Low serum zinc level testing should be repeated for laboratory error. Zinc deficiency is easily treated with oral supplements.
Studies say that the food eaten by a breastfeeding mother affects the composition, frequency and consistency of the infant’s urine and stool. Also, at around the age of four months, infants start eating solid foods also triggering the change in their urine and stool. These changes in the composition of urine and stool can very easily trigger rashes.
Antibiotics: The antibiotics taken by the breastfeeding mother of the infant can well be the reasons for such rashes. Please speak to your doctor and get help.
Ever Dry Nappy
Since ever dry nappy was introduced, the most important predisposing factor we have seen is “using nappy cream or Vaseline”. In the past the cream was used to help reduce urine and feces coming in contact with skin in groin area. Vaseline or cream will clog the pores in the ever dry nappy resulting in stagnation of urine and feces coming in contact with the skin.
Patients with nappy rash present with an erythematous scaly nappy area often with papulovesicular or bullous lesions, fissures, and erosions. The eruption may be patchy or confluent, affecting the abdomen from the umbilicus down to the thighs and encompassing the genitalia, perineum, and buttocks. Children with nappy rash have marked discomfort from intense inflammation and are often irritable (excessive crying, poor feeding and generally unwell). Rule out a secondary yeast or bacterial infection, which may occur in the area.
When the “Crease is involved” (Ref: Picture below) the rash is likely to be infected. You must start treatment-using antifungal and may be antibiotic cream. You must also start giving oral antifungal treatment (Ref: Oral Thrush)
Rashes when infected by bacteria will appear a bit different from general rashes. In this case, the common red rashes transform into small fluid-filled bumps that may appear yellow in color. The area looks like impetigo and is often caused by the same bacteria (Staphylococcus). You must consult a doctors and get the right treat with an the correct antibiotics.
Infection in individual who is immune-suppressed (children treated with steroids, cancer treatment, post transplant surgery, combined immune deficiency or HIV infections) can go on to develop serious systemic infection. Rash incorrectly diagnosed or treated as eczema using steroids certainly may lead to significant morbidity and mortality. Steroid suppress protective immune response (immune-compromised) resulting in serious secondary bacterial or fungal infections. Babies are also susceptible to infections with other bacterial super-infections and antibiotic resistant bacteria like e-coli.
Morbidity associated with nappy rash is discomfort, poor feeding, failure to thrive and the possibility of secondary bacterial or candida infection.
The pictures above help you differentiate infected rash from non infected rash (contact dermatitis). Please remember a non-infected rash can get infected any time. Make sure you carefully monitor feeding, sleeping pattern, temperature and other signs like vomiting.
You can see how the skin in contact with urine and stool will be inflamed and look dry and reddish. Exposing the area to air is one of the best ways to help reduce secondary infection. Boys must always get urine culture to help reduce complications like urinary infection. Remember babies with urine infection often vomit and may not have any other symptom to help us diagnose urinary tract infection. Please read all about urinary tract infection to prevent long term complications.
These are simple rashes that were diagnosed as eczema and treated with creams and emollients as advised in the guidelines. When the rash does not get better, the steroid cream are often prescribed. Some doctors and nurses do not stop to think “Why the rash did not get better?” but will assume their diagnosis is right and continue to treat or add on another drug or cream.
The notes of two patients clearly demonstrate wrong diagnosis and treatment result in prolonged suffering and complications. I will soon publish similar notes and pictures about a baby with a nappy rash spreading all over the body because steroid was prescribed by a nurses not realising this could help fungal infection spread all over the body.