Nappy Rash
Red, sore skin under the nappy and a baby who protests at every change. Nappy rash affects more than half of babies by their first birthday. Most clears with simple changes and a thick layer of barrier cream.
Why it happens: wee and poo keep the skin wet, and the nappy rubs it. That irritation is the most common cause. Diarrhoea, antibiotics, fragranced wipes, soaps and detergents can make it worse.
Thrush (candida): a yeast infection that likes skin folds. It often looks bright red in the creases with small spots or pimples around the edges, and may take longer to clear or come back.
Other causes: eczema, psoriasis, seborrhoeic dermatitis, impetigo and a strep infection around the bottom can look like nappy rash. A rash that doesn’t respond to the usual care needs a doctor’s look.
The nappy rash ladder
Barrier cream and frequent changes fix most nappy rash. A mild steroid helps stubborn inflammation; antifungal cream treats thrush.
- Step 1 · Self-careFrequent changes and nappy-free timeChange wet or dirty nappies promptly: about 5 to 7 times a day for babies under 12 months. Clean gently with lukewarm water and a soft cloth, pat dry, and give some nappy-free time each day. Good-quality disposable nappies absorb best.
- Works
- The most important step for prevention and healing
- Cost
- Free
- How long
- Ongoing
- Watch for
- Plastic pants and tight nappies trap moisture.
Fresh air: the cheapest cream there is.
- Step 2 · PharmacyThick barrier cream at every changeUse a thick layer of a zinc or petroleum-based cream. Don’t scrub it all off at each change; just remove the soiled part and add more on top. If a low-zinc cream isn’t working, try a higher-strength zinc paste.
- Works
- Effective for irritant nappy rash, the most common type
- Cost
- About $10–20
- How long
- Every change, until healed and beyond
- Watch for
- If it wipes off easily, try another brand.
Think icing, not a glaze.
- Step 3 · Pharmacy or GPMild steroid cream (hydrocortisone 1%)For rash that doesn’t settle with the steps above. Applied once or twice a day for 1 to 2 weeks, under the barrier cream.
- Works
- Settles inflammation in stubborn rash
- Cost
- About $10–15
- How long
- 1 to 2 weeks
- Watch for
- Use only as directed and for a short time. Ask your pharmacist or GP first.
A small tube for a short time.
- Step 4 · GPAntifungal cream for thrushClotrimazole or miconazole cream twice a day. Some products combine an antifungal with hydrocortisone or zinc.
- Works
- Treats thrush; finish the full course even when the rash looks better
- Cost
- About $10–15 from a pharmacy
- How long
- Usually 1 to 2 weeks
- Watch for
- Go back if it isn’t working. Thrush can come back.
Yeast loves a warm, damp fold. Take away the welcome mat.
- Step 5 · GPChecking for other causesYour GP looks for bacterial infection, eczema, psoriasis and rarer conditions if the rash is severe, unusual or not responding.
- Works
- Finds the rash that was never “just nappy rash”
- Cost
- Often bulk billed for children; varies
- How long
- Depends on the cause
- Watch for
- A fever, blisters or pus need a prompt check.
If the usual fix doesn’t fix it, it may not be the usual rash.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Talcum powderNot recommended for nappy rash.
- Antiseptic creamsNot recommended. They can irritate the skin further.
- Soap, bubble bath and fragranced productsThey irritate sore skin. Products with plant or nut oils can too.
- Rubbing the skin dryPat dry instead. Rubbing damages already sore skin.
What you can do
- Change nappies as soon as they are wet or dirty.
- Give nappy-free time on a towel when you can.
- Use water and a soft cloth. If you use wipes, choose fragrance-free and alcohol-free ones (Australian hospital advice is to avoid wipes on a sore bottom).
- Apply a thick barrier cream at every change.
- One warm bath a day with a fragrance-free wash is plenty.
- For dry, itchy skin elsewhere, see our eczema fact sheet.
See your GP if
- The rash hasn’t improved after a week of good care
- It is severe, spreading or more painful than usual
- You see blisters, pus, yellow crusts or bright red, shiny skin around the bottom
- Your baby has a fever or seems unwell
- The rash keeps coming back
See a doctor urgently if
- Your baby has a fever and seems unwell with the rash
- The rash is spreading quickly, or has blisters or open sores
- Your baby is in a lot of pain, can’t settle, or isn’t feeding
Call 000 (Australia) or your local emergency number if your baby is floppy, very drowsy or hard to wake, struggling to breathe, or has a rash that doesn’t fade when you press a glass on it.
Common questions
How do I get rid of nappy rash fast?
Change nappies often, give nappy-free time, clean gently with water and apply a thick barrier cream at every change. Most irritant nappy rash improves within days. See a GP if it isn’t better in a week.
How can I tell if nappy rash is thrush?
Thrush is often bright red in the skin folds with small red spots around the edges, and doesn’t improve with barrier cream alone. It needs an antifungal cream.
Should I wipe off all the barrier cream at each change?
No. Remove the soiled part and put more on top. Scrubbing it off damages the skin.
Are cloth nappies or disposables better for nappy rash?
Good-quality disposable nappies absorb moisture better. If you use cloth nappies, rinse them well and avoid plastic pants.
Helpful resources
- Royal Children’s Hospital: Nappy rashParent fact sheet. Free, Australia.
- NHS: Nappy rashCauses, prevention and treatment. Free, UK.
- Eczema fact sheetWhen dry, itchy skin is the problem. Free, from us.
Evidence and more information
- Royal Children’s Hospital Melbourne: Nappy rash clinical practice guideline
- Royal Children’s Hospital Melbourne Kids Health Info: Nappy rash
- NHS: Nappy rash
maladywise.com/nappy-rash/