Types of nappy rash

Nappy rash is very common and most babies have at least one bout during their nappy-wearing years. The important thing is to identify the cause of the rash quickly to avoid wasting time on "cures" unsuited to the condition.

Rashes tend to fall into three categories:

"Ordinary" nappy rash: This is usually short-lived, lasting a day or two. It can be the result of teething, wearing a dirty nappy for too long or a reaction to baby wipes or a particular nappy brand. This is best treated with a good barrier cream, such as zinc and castor oil or Sudocrem. Add to that plenty of nappy-free time and ensure baby's bottom is cleaned with just warm water and a soft cloth, then dried thoroughly.

Thrush (or candida): This is identified by a rash with red spots in the genital area and maybe white spots in the mouth. But you'll know your baby is likely to have thrush if the rash fails to clear up after a few days, despite your best efforts.

Christchurch paediatrician Dr Maud Meates-Dennis (www.baby-medical-questions-and-answers.com) says thrush is easily identifiable by spots surrounding the inflamed area. The best treatment is an anti-fungal cream from your doctor (some preparations have a mild steroid mixed in). However, she also recommends oral drops such as Nilstat to treat any yeast (candida) in the gut - without that the nappy rash will just keep coming back.
Acidophilus, bifidus and candida usually live harmoniously in the gut but at times of stress or illness, the balance can get out of kilter, causing an over-growth of candida

Naturopath Natasha Berman from qbaby qbaby.co.nz recommends as much nappy-free time as possible, as wet nappies help develop fungal growths such as thrush. But she also makes a natural soothing anti-fungal cream with ingredients such as citrus seed, oregano oil, calendula and liquorice which has anti-inflammatory properties.

She recommends a probiotic to restore the balance of bacteria in the gut such as BioCeuticals Baby Biotics for infants under two months, and Childlife Colostrum with Probiotics for three months and up.

Acidophilus yoghurt does not have enough of the good bacteria to fix a deficiency in the gut but Natasha says it makes for a soothing cream and could be dabbed on the baby's bottom.
If baby is breastfeeding the mother will also need to be assessed and treated for thrush as it's very likely she will also have it.

Eczema: This is another common ailment that tends to show up between three and six months of age. Eczema is typically identified by dry, inflamed skin that's likely to appear on other parts of the body as well as the nappy area. The inflamed skin is prone to be irritated and so nappy rash is not uncommon in babies with eczema.

Dr Maud prescribes a steroid cream for eczema if it is inflamed but it is important to keep using moisturisers to keep  the skin moist.  A barrier cream can be used as well to prevent irritation.

As this can be a chronic condition it pays to investigate further if you think your baby has eczema. Natasha says in many cases eczema is the result of allergies. The first step is to find out what is causing the problem so it can be eliminated. Natasha recommends a hair test through allergenicstesting.com, then a naturopath's recommendation on treatment products.