Nappy rash is easily identifiable by the redness it causes in the nappy area, a sign of an inflammatory reaction. It also results in increased skin sensitivity, and can even cause burning sensations and itching. How can you soothe nappy rash? Discover more by continuing to read.
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Nappy rash: what are the possible treatments?
Summary
- Corticosteroids, potent anti-inflammatory agents
- Antibiotics and antifungals, in the event of a suspected infection
- Zinc oxide-based creams, a gentle solution
- Plant extracts, for a natural approach
- Sources
Published March 11, 2025,
updated on March 12, 2025,
by
Pauline, Chemical Engineer
—
7 min read
Corticosteroids, potent anti-inflammatory agents.
Topical corticosteroids are frequently used to alleviate outbreaks of eczema. These are potent anti-inflammatory agents that work by modulating the immune response. Their mechanism of action is primarily based on their ability to interact with intracellular glucocorticoid receptors, which are present in the cytoplasm of skin cells. Once bound to these receptors, the corticosteroids penetrate the nucleus and alter the expression of genes involved in inflammation, particularly those coding for pro-inflammatory cytokines IL-1 and IL-6, which are involved in the onset of redness. In the case of nappy rash, the inflammation is due to repeated mechanical and chemical irritation, coupled with an alteration of the skin barrier. The application of topical corticosteroids can rapidly reduce this inflammation.
The primary corticosteroids used to manage nappy rash include hydrocortisone, at 0.2%, 0.5%, or 1%, desonide at 0.05%, triamcinolone at 0.1% and betamethasone at 0.05% or 1%. However, while these molecules have a good immunosuppressive action, they can also weaken the skin barrier and promote infections. That's why their use should be short, targeted and under medical supervision. It is generally advised to apply the corticosteroids in a thin layer twice a day for two weeks on the area prone to nappy rash.
Antibiotics and antifungals, in the event of a suspected infection.
If a bacterial infection is suspected, a doctor or pharmacist may advise supplementing the therapy with topical antibiotics, to be used two to three times a day for a maximum of ten days. In the absence of improvement, oral antibiotics effective against staphylococci (cephalexin) and streptococci (penicillin-macrolides) are recommended. When the staphylococcus is resistant to penicillin, a treatment based on sulfamethoxazole or clindamycin should be considered. For comprehensive management of nappy rash, it is important to not prematurely discontinue the antibiotic treatment, even in the case of visible improvement, to avoid recurrence of the infection and the selection of resistant strains.
When a fungal infection is suspected, healthcare professionals administer antifungal medications, most commonly nystatin. Nystatin binds to ergosterol, a crucial component of the fungal cell membrane, leading to a potassium leakage which results in their death. Nystatin also impacts the transport capacity of cell membranes through lipid peroxidation. Nystatin-based creams are used several times a day for seven to ten days. The application can be reduced to twice a day when the substance is combined with triamcinolone, one of the corticosteroids mentioned above. Other antifungal medications can combat nappy rash, such as clotrimazole, miconazole nitrate, or ciclopirox.
Zinc oxide-based creams, a gentle solution.
Another essential in the therapeutic arsenal against the nappy rash are creams based on zinc oxide, a compound with almost no solubility in water and with anti-inflammatory and regenerative effects. Ointments containing zinc oxide act as a physical barrier to water absorption and, by inhibiting the adhesion and penetration of microorganisms, reduce the risk of infections in cases of nappy rash. In these creams, zinc oxide is often combined with glycerine, as is the case in Eryplast for example, or lanolin, as in Oxyplastine. Another advantage of these ointments: they are not associated with any significant side effects. For a better therapeutic effect, zinc oxide-based creams should be applied after each nappy change.
Plant extracts, for a natural approach.
Finally, in addition to the treatments mentioned above, certain natural solutions effectively soothe the nappy rash.
Calendula is a medicinal plant with anti-inflammatory and healing properties that are particularly suited to nappy rash. Thanks to its richness in flavonoids, it is capable of inhibiting the production of pro-inflammatory mediators, such as prostaglandins, thus reducing local inflammation and the characteristic redness of the nappy rash. Furthermore, calendula stimulates fibroplasia, keratinoplasia, and angiogenesis. It thus positively impacts the proliferative phases of the healing process. Generally applied in the form of an oil macerate, calendula helps to soothe the skin while forming a protective barrier against the moisture of nappies and friction.
Chamomile is also renowned for its anti-inflammatory action, particularly due to the terpenes it contains. These molecules modulate the activity of cyclooxygenase and lipoxygenase, thereby reducing the production of inflammatory mediators responsible for redness and burning sensations observed in nappy rash. Thus, chamomile extract is an ally in soothing irritations and strengthening the skin barrier.
Rich in polysaccharides and hygroscopic amino acids, aloe vera gel is recognised for its ability to form a moisturising film on the skin's surface, thereby reducing transepidermal water loss and maintaining an environment conducive to healing. It also contains glucomannan, a compound that upregulates the growth factor of fibroblasts (TGF-β1) and increases their activity, thus accelerating skin regeneration. Additionally, aloe vera gel has an immediate cooling effect that provides a soothing sensation for the skin.
Finally, sunflower oil is a significant source of linoleic acid, a fatty acid that plays a key role in rebuilding the skin's hydrolipidic film. In infants suffering from nappy rash, the impairment of the skin barrier leads to increased water loss and greater vulnerability to irritants such as urine and faeces. Furthermore, sunflower oil has beneficial antibacterial properties to prevent infection in the nappy area in cases of nappy rash.
Note : The list above is not exhaustive, other botanical extracts are recognised for their ability to manage nappy rash.
Sources
SCHEINFELD N. Diaper dermatitis: a review and brief survey of eruptions of the diaper area. American journal of clinical dermatology (2005).
TIERNEY N. & al. Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management. Pediatric Dermatology (2013).
NIU G. & al. Safety evaluation for ingredients used in baby care products: Consideration of diaper rash. Regulatory Toxicology and Pharmacology (2017).
HASANPOOR-AZGHADI S. B. & al. A Review Study of Diaper Rash Dermatitis Treatments. Journal of Client-Centered Nursing Care (2018).
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