Nappy rash - how to prevent, manage and when to get help

Dr Kara Johns
Creator and Director of SBK


Have you been scrolling the internet late at night trying to work out how best to care for your baby's red bottom? Parenting is hard enough without the dreaded nappy rash rearing its head, yet it seems to impact most baby’s at least once. Having a game plan on how to deal with your baby’s red bottom is useful, as the sooner you address it, the more likely it won’t become a total nightmare!

In this blog, i’m going to cover what nappy rash is, what it looks like, how to prevent it, how to address it when it pops up and when it’s time to see your baby’s GP.

As always, if you have any comments or questions, please feel welcome to drop me an email on

Off we go!


What is nappy rash?

Essentially it is any rash that appears under a nappy! It is not a medical term, so does not mean a specific rash type or cause.

There are several rashes that can appear under your baby’s nappy, but by far the most common is an ‘irritant contact dermatitis', where the irritant is the baby’s own urine and faeces. The irritation possibility increases the longer the urine and faeces are in contact with the skin, which nappies achieve beautifully! This can then be worsened if certain nappies, wipes or creams are being used that contain known skin irritants.

Add to all of this that baby’s skin is not as tough as adult skin, so it is more easily irritated.

Irritated bottom skin is really uncomfortable for babies and they will usually let you know about it by being unsettled, not wanting their nappy changed, becoming distressed when you do change their nappy or try to give them a bath. The good thing though, is that this type of nappy rash can often be prevented and managed with some simple measures, that will be discussed here.

Other causes of rashes under a nappy can occur on their own or in combination with an irritant contact dermatitis, which then makes the overall rash harder to treat and sort out. This is the case when a fungal or bacterial infection occurs in combination with an irritant contact dermatitis.

Other rashes may include: psoriasis, seborrheic dermatitis, eczema and hand food and mouth (which is caused by several different viruses).

The rest of the blog is going to be addressing irritant contact dermatitis nappy rash.


What does irritant contact dermatitis nappy rash look like?

It can appear differently depending on how severe it is.
  • It usually starts with the skin starting to appear red
  • The red area can then increase a lot - both in ‘redness’ and the area that it covers
  • It may start to appear raised where the redness is, as the area can swell
  • Or even dry with cracks
  • The edge between healthy skin and rash skin is usually obvious
Check out this link for photo examples of how irritant contact dermatitis can appear in the nappy area.


How can irritant contact dermatitis nappy rash be prevented?

As it is typically caused by urine and faeces being in contact with the skin, the best preventative measure is to limit your baby’s skin contact to both. Here are some strategies that may help:

  • If using disposable nappies,
    • make sure they are high absorbent that have a moisture wicking layer that contacts with your babies skin. This pulls the urine into the nappy instead of sitting on the nappy, where it will be in direct contact with you baby’s skin.
    • Makes sure you are using a brand that is not using a fragrance on the liner or absorbent layer - as this can worsen any skin irritation that forms.
    • change nappies frequently during the day - 3-4 hourly
    • Always use a barrier cream with every nappy change - regardless of what the skin looks like. Apply a thick layer of nappy cream before bed, when the nappy may stay on for longer.
  • If using cloth nappies,
    • make sure you are washing them effectively. Most brands will have a pitiful washing guide that will absolutely not clean them effectively. Check out for excellent washing instructions. Sure, your cloth nappies won’t last as long, but its more important that they do their job without irritating you baby’s skin!
    • Dry nappies in the sun wherever possible, as this also is a sanitising step.
    • Use a washable liner that has effective moisture wicking properties - such as micro-fleece. I bought 1m from the local fabric store for about $5-10 and cut it into strips thin enough to sit inside the nappy, yet wide enough to cover most of the skin contact area - this ensures any liquid is pulled away from the skin and into the nappy.
    • Always use nappy cream! Most cloth nappy brands will tell you not to use a nappy cream as it will shorten the life of the nappy. This is true, but using washable liners is a great way to compromise on this, as the cream will go onto the liner and not the nappy - so won’t actually shorten their life, yet still help to prevent a nappy rash. Wash the liners separately to best preserve your nappies.
  • Other measures:
    • Choose your nappy balm carefully!
      • Make sure it is fragrance free! Fragrance is a skin irritant, especially essential oils. Plus, all that fragrance is doing is enticing you to use it, not actually helping your baby’s skin. 
      • An every day preventative bottom balm to use for prevention does not need to be zinc based. It does need to be emollient based so that is what covers the skin to protect if from contact with urine and faeces. A product that sinks into the skin is not appropriate.  Vaseline is fine, as it plant wax.  But i’d always favour a zinc based product as it is soothing to the skin and can address small irritations before you notice them.
    • Think about other products that come in contact with you baby’s skin and make sure they are truely suitable
      • This includes bath wash, bubble bath, moisturiser, massage balm/oil - they all need to be fragrance free and not include harsh surfactants/soaps. Remember, baby’s skin is not as tough as adult skin, so weakening it with exposure to skin irritants will then make irritant contact dermatitis more likely.
    • Use basic wipes - dedicated cloth wipes (such as face washers that you just use for bottom care!) with warm water is all that is needed. Disposable wipes are often easier, so make sure they are non-fragranced and gentle.

Once you see redness starting - what do you do?

Redness is often the first sign that irritation to the skin has started. Take steps now to calm the skin down and reduce the chance of it progressing.

  • Increase the frequency of nappy changes. 2 hourly at most during the day.
  • Ensure nappy free time for your baby, several times a day for as long as possible. I bought several bed wetter protector sheets and would lay that on the carpet - then any accidents didn’t get on the carpet! Buy several so you always have a clean one. You want to do this as often as you can.
  • Change to a nappy cream that has at least 15% zinc oxide - because this is skin soothing as well as barrier protecting. Zinc also has an antibacterial action, so can help to prevent a secondary bacterial infection.
  • Ideally switch to a nappy cream that also has skin soothing/repairing ingredients. Quite a few products in the pharmacy will have cod liver oil in them for this purpose. If you want a plant version, look for ingredients like oat/rice extract and glycerine.
  • Apply nappy cream with every nappy change - in a thick layer now. You shouldn’t be able to see skin through the zinc. You don’t need to totally remove the previous layer, as remember, if it is still on the skin, it was preventing the urine and faeces from touching the skin. Remove any visibly soiled.
  • Most guidelines will tell you to change to disposable nappies at this point in time. In my experience, if you are washing the nappies effectively and using a moisture wicking liner with nappy cream - this won’t be necessary. But if you are not winning, its a useful step to try.

Typically, the redness will settled within a day or so.


When to see your baby’s GP?

If you are ever concerned, it is always a good idea to talk to your baby’s GP. A significant rash may need topical prescription creams to help settle it down or to reconsider if it is something other than irritant contact dermatitis.

Consider heading in for a review if:
  • If the redness persists or worsens after a few days of the above steps
  • if you notice a white scaling appearance - which may suggest an additional fungal infection
  • If it becomes extremely red that you are concerned
  • If it becomes oozy/bleeding
  • If you baby is extremely distressed by the rash
  • If your baby has a fever that can’t be explained by something else (such as immunisations or a viral illness)


What makes the SBK bottom balm so good?

- plant based
- 20% zinc oxide
- contains wound healing centella asiatica extract
- fragrance free
- plant oils that have nourishing and moisturising fatty acids
- contains soothing shea butter
- contains anti-inflammatory green tea extract

Mateo was still in nappies when I started working on SBK and I soon realised that the nappy balm space was confusing for parents.  There was either the mass marketed pharmacy/supermarket products that were simple from a formulation perspective; or, the newer plant based products that contained skin irritant ingredient/s.

Simple products are fine - they do the job.  But I loved the idea of a plant based product and could see that there was potential to create an exceptionally good product.  If only the brands left out the skin irritant ingredients! 

The most significant idea I had was to create a nappy balm with centella asiatica extract in it. Centella is a plant mostly found in Asian countries and has been studied for a variety of skin conditions, with some promising results. The most intriguing studies to me were those that found centella asiatica extract assisted the skins wound healing process, which is exactly what irritated skin needs help with. (Arribas-López E, et al,. A Systematic Review of the Effect of Centella asiatica on Wound Healing. Int J Environ Res Public Health. 2022 Mar 10;19(6):3266.)

To my knowledge, at the time of writing this blog, SKB bottom balm is the only bottom balm on the market that includes centella asiatica extract!

I was so impressed with the prototype that I knew I had to include a baby line in SBK!  It performed so well in terms of how silky it was to spread on the skin, but also how quickly it dealt with my son’s red bottom. Now - to be clear - I have not put this product through an extensive randomised control trial to test its effectiveness as a treatment for irritant contact dermatitis because I am not a multimillion dollar company - so I can’t claim that is is a treatment product! But it does contain ingredients that have been studied, at concentrations that have been studied. Oh, and it has 20% zinc oxide in it - above some of the standard products!

May there be no more little red bottoms!

Kara. xx


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