Obviously it happens in babies and young children. This is because of prolonged contact of the skin with urine and faeces under an occlusive environment, and results in essentially a contact eczema caused by ammonia, and the effects of gut bacteria.

It is not so common in the first month of life but becomes increasingly common afterwards. It affects the nappy area - buttocks, genitalia, lower abdomen, and upper inner thighs, but sparing the skin creases, where the skin is folded and has not been in contact with the excreta.

Signs

Napkin eczema is a red rash easily diagnosed by its distribution. Usually it is mild with some redness. Occasionally it can be severe with ulcers and blisters.

Thrush is a yeast infection of the skin that is also common in children at the nappy stage. It also gives a red rash, but is most obvious deep in the skin creases, so in theory making the two conditions distinguishable. In practice, they often co-exist.

Management & Treatments

Hygiene is the most important part. Modern disposable nappies have good moisture-absorbing properties, but still need to be changed often if skin irritation is to be avoided. Some barrier creams can also be applied in the napkin area to act as a block of the contact.

The affected area should be washed with water added with some mild moisturiser. Soap or disinfectant should not be used. Mild cases will get better on their own and there is no need to seek medical attention.

If the situation does not improve or is severe, you should take the baby to see the doctor who may use a mild steroid cream. If there is secondary infection with bacteria or fungi, then a cream with antibiotics or anti-fungals would be used.

It is not a problem to use steroid as long as you apply the mildest preparation and for the shortest time necessary. 0.5 % hydrocortisone cream is very safe if used this way.