Nappy rash

What it is

Nappy rash is red, sore or dark patches in the nappy area caused by contact with urine and stool. Most babies get it at some point.

How it works

Urine and stool irritate the skin; enzymes in stool break down the barrier and moisture makes it more permeable.

Why it matters on darker skin

Heat and humidity worsen it, and in darker skin it can look dark and shiny rather than red. A yeast (thrush) infection can complicate it.

Causes and triggers

Infrequent changes, diarrhoea, antibiotics (which encourage yeast), fragranced wipes.

What helps — and why it works

Change nappies often, clean gently with water, pat dry and allow nappy-free time. Apply a thin barrier cream at each change. Use the right size nappy. Frequent changes and nappy-free time: reduces contact with irritants. Expected timeline: 1–3 days. Thick barrier cream (zinc oxide or petrolatum): forms a shield. Expected timeline: each change. See a doctor if it persists: yeast infection needs antifungal cream.

What to avoid and why

Avoid scented wipes, talc, harsh soaps and medicated or steroid creams unless advised.

Common mistakes

• Talc or baby powder.
• Scrubbing.
• Strong steroid creams.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.