Nappy rash is a skin inflammation that, in its initial days, is harmless. However, if not properly managed, it could potentially progress into a more serious condition. How should one respond to severe nappy rash? Let's discover this together.
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Severe nappy rash: how to treat it?
Summary
Published March 12, 2025,
updated on March 12, 2025,
by
Pauline, Chemical Engineer
—
4 min read
How does a severe case of nappy rash present itself?
Primarily affecting infants, nappy rash is a skin inflammation occurring in the buttock, thigh, and groin areas due to a combination of mechanical, irritative, and infectious factors. It specifically arises in response to prolonged exposure to moisture and urine and faeces retained in nappies, which contain skin-irritating agents. In response, the skin turns bright red and sensations of burning and itching may appear. If the nappy rash is not managed, it can progress beyond the initially affected area and reach the genital areas. The onset of fever, rapid skin swelling, as well as oozing and/or malodorous blisters may also indicate that the nappy rash is becoming severe. At this stage, the skin is usually very painful, making any contact with nappies or underwear particularly difficult.
The worsening of nappy rash is often due to an infection by pathogenic microorganisms.
What to do in case of severe nappy rash?
If you are dealing with a severe case of nappy rash, it is essential to seek medical advice.
This can guide you towards a treatment that quickly soothes the skin. Most often, in cases of severe nappy rash, corticosteroids are prescribed for two weeks. Hydrocortisone at 1% is one of the standard treatments for babies, as stronger corticosteroids can lead to serious side effects in this vulnerable population, such as skin atrophy, intracranial hypertension, growth delay, or Cushing's syndrome. If the nappy rash affects an adult, other corticosteroids are possible, such as desonide, triamcinolone, and betamethasone.
However, dermocorticoids alone are typically not sufficient to curb severe nappy rash. Often associated with colonisation by microorganisms, severe nappy rash requires more comprehensive medical intervention. In the case of a fungal infection, agents such as nystatin, clotrimazole, miconazole, ketoconazole or sertaconazole can be applied at each nappy change. In the presence of bacterial colonisation, the doctor may prescribe antibiotics. Applying mupirocin twice a day for five to seven days is usually enough to effectively curb the infection in most cases.
How to prevent a nappy rash from worsening?
Even though a severe nappy rash can be relatively easily treated, the ideal is to prevent it from worsening. To do this, it is primarily necessary to keep the buttock area clean, by regularly changing nappies and clothes soiled by urine or faeces. It is also recommended to clean it twice a day with warm water and a mild soap, and to thoroughly dry the skin with a clean towel, gently patting it. In addition, you can apply an emollient cream designed for this purpose after each nappy change, in order to strengthen the skin barrier.
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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