Nappy Rash: How to Treat It and When to Worry
In short: Most nappy rash is irritation from wet or dirty nappies rubbing on the skin, and it usually clears within a few days with frequent changes, gentle cleaning with water, nappy-free time and a thick layer of zinc or petroleum-based barrier cream. A rash that is bright red in the skin folds, has blisters or pus, comes with fever, or is not better after two to three days of good care should be seen by a doctor.
Key takeaways
Nappy rash is very common in babies and toddlers and is usually caused by urine and stool sitting against the skin, plus friction from the nappy.
A thick layer of zinc oxide or petroleum jelly at every change protects the skin while it heals.
Most simple nappy rash improves within two to three days of careful care.
A shiny, bright red rash that is worst in the skin creases, with small spots at its edges, is often a yeast (candida) infection that needs an antifungal cream.
Talcum powder, antiseptics and over-the-counter antibiotic ointments should not be used on nappy rash.
What causes nappy rash?
Nappy rash happens when urine, stool and friction break down the protective outer layer of a baby's skin, letting irritants and germs in.
A baby's skin is thinner than an adult's and loses its barrier quickly when it stays damp. Urine makes the skin soggy. Stool contains enzymes that irritate it further. The nappy then rubs against the softened skin at every kick. The result is the familiar red, sore patch on the bottom, genitals and upper thighs.
What makes it more likely?
Diarrhoea, or any time stools become more frequent or looser.
A course of antibiotics, which can allow yeast to overgrow.
Starting solids, which changes the stool.
Nappies that are changed less often, such as overnight, during long drives or on busy days.
A nappy that is too tight, or a new brand of nappy, wipe or cream.
Heat and sweat. In Malaysia's humid weather, the skin under a nappy rarely gets a chance to dry out on its own.
Can teething cause nappy rash?
Many parents notice a rash during teething. Teething itself does not irritate the skin, but some babies drool more, swallow more saliva and have slightly looser stools at that time, which can tip the balance. If your baby also has a high fever or is clearly unwell, look for another cause rather than putting it down to teeth.
What does nappy rash look like, and is it fungal?
Simple irritant rash is pink or red on the skin that touches the nappy and spares the creases; a yeast rash is bright red, shiny, worse in the creases and often has small separate spots around its edge.
Irritant nappy rash
Pink or red patches on the rounded parts: buttocks, outer labia or scrotum, upper thighs.
The deep skin folds usually look normal, because the nappy does not touch them.
The skin may feel warm and look slightly shiny or dry.
Yeast (candida) nappy rash
Bright red or deep pink skin with sharp edges.
Worst in the groin folds and creases.
Small red spots or pimples dotted just beyond the main rash.
Often appears after antibiotics, or after an ordinary rash has lasted more than a few days.
Your baby may also have white patches in the mouth (oral thrush).
What else can look like nappy rash?
A few other conditions can appear in the nappy area and need different treatment. Seborrhoeic dermatitis gives greasy, salmon-pink patches that often also show on the scalp as cradle cap. Eczema can affect the nappy area, though it is usually worse elsewhere. Bacterial infections can cause yellow crusts, blisters or bright red skin around the anus. A rash that keeps coming back despite good care deserves a proper look.
How do I treat nappy rash at home?
Change nappies often, clean gently with water, let the skin air, and apply a thick barrier cream at every change; most rashes improve within two to three days.
Step by step at each change
Change the nappy as soon as it is wet or dirty. Babies under 12 months usually need around five to seven changes a day, more if stools are frequent.
Clean with lukewarm water on cotton wool or a soft cloth. For a very sore bottom, pour or squirt water over the area instead of rubbing.
Pat dry gently, or let the skin air dry for a few minutes. Do not rub.
Apply a thick layer of zinc oxide cream or paste, or petroleum jelly, so you cannot see the skin underneath. Think of icing a cake.
You do not need to scrub all the old cream off at the next change. Clean away the soiled layer and add more on top.
Fasten the nappy so it is snug but not tight, with room for air.
Why does nappy-free time help?
Air is one of the best treatments. Lay your baby on a towel or waterproof mat without a nappy for 10 to 15 minutes a few times a day. In a cool room or under a fan, the skin dries out properly, which it rarely does inside a nappy in our climate.
Cloth nappies, disposables and wipes
Good-quality disposable nappies pull moisture away from the skin and are usually best while a rash is healing.
If you use cloth nappies (lampin), change them very often, rinse detergent out thoroughly, and avoid plastic covers that trap heat while the rash is active.
Baby wipes can sting broken skin. Use water while the rash heals. If you do use wipes, choose ones without alcohol or fragrance.
When to see a doctor, and when not to worry
A mild red rash in a baby who is feeding and well can be treated at home, but blisters, pus, fever, or a rash that is not improving after two to three days need a doctor.
Usually fine to manage at home
Pink or red skin on the areas the nappy touches, in a baby who is feeding, weeing and behaving normally.
A rash that started during a bout of loose stools and is settling as stools return to normal.
A rash that looks a little better each day with barrier cream and frequent changes.
Book an appointment soon
No improvement, or getting worse, after two to three days of careful treatment.
Bright red rash in the skin folds with spots at the edges, which suggests yeast.
A rash that keeps coming back, or nappy rash alongside patches elsewhere on the body.
White patches in the mouth together with the nappy rash.
Rash that started during or after a course of antibiotics.
See a doctor the same day
Blisters, pus-filled spots, yellow crusts, weeping or open sores.
Fever together with the rash, or any fever of 38°C or above in a baby under 3 months.
A rash that is spreading quickly, very painful to touch, or swollen and hot.
Bleeding from the skin.
A baby who is unusually sleepy, floppy or feeding poorly, or who has had very few wet nappies.
Diarrhoea with signs of dehydration, such as a dry mouth, no tears or a sunken soft spot.
What can I do at home to prevent nappy rash?
Prevention is mostly about keeping the skin dry and protected: frequent changes, a thin barrier cream as routine, and extra care at times of higher risk.
Newborns and young babies (0 to 6 months)
Expect frequent changes, as newborns wee and pass stools often.
Use plain water and cotton wool for cleaning in the first weeks.
Apply a thin layer of barrier cream at changes, especially overnight.
Fold the nappy below the umbilical stump until it falls off.
Older babies (6 to 12 months)
Watch for a rash in the first weeks of solids and after any new food that loosens stools.
Go up a nappy size if marks are left on the thighs or waist.
Use a thicker barrier layer and an extra change on long car journeys or days out.
Toddlers
Check and change after naps and before long drives through traffic.
Allow nappy-free time at home, which also helps when you start toilet training.
Make sure the taska or babysitter knows which cream to use and how often to change.
What not to do
Do not use talcum powder (bedak) on the nappy area. It can be breathed in and does not protect the skin.
Do not use antiseptic liquids, alcohol or perfumed products on the rash.
Do not use over-the-counter antibiotic ointments. They can irritate the skin further.
Do not use steroid creams unless a doctor or pharmacist has advised it for your baby.
Do not scrub the skin clean or use soap at every change.
Do not fasten nappies tightly to stop leaks, especially overnight.
From Dr Nisa's clinic: When parents bring a baby with a nappy rash that will not go away, the story is often similar. They have tried three or four different creams, each for a day or two, and the rash keeps coming back. Very often it has become a yeast rash, and a barrier cream alone will not clear it. Once we treat the yeast and keep the skin dry, most babies are comfortable again within days. Switching creams quickly usually helps less than one correct treatment used properly.
Worried about your baby's nappy rash?
I am Dr Nisa Khalil, a consultant paediatrician with more than 18 years of experience caring for babies and children, based at ParkCity Medical Centre in Kuala Lumpur. If your baby's rash is not settling, keeps returning, or you are unsure whether it is infected, I can examine your baby and recommend the right treatment.
Book an appointment at ParkCity Medical Centre, or start with an online eConsult and share a photo of the rash.
You may also find these helpful:
Frequently asked questions
How long does nappy rash take to heal?
Most simple nappy rash improves within two to three days and clears within about a week with frequent changes, nappy-free time and a thick barrier cream. If the rash is no better after two to three days of careful treatment, or is getting worse, see a doctor. Yeast rashes usually need an antifungal cream and can take a little longer to settle completely.
How do I know if nappy rash is fungal?
A fungal or yeast rash is usually bright red and shiny, with sharp edges, worse in the skin folds of the groin, and often has small red spots just outside the main rash. It commonly follows antibiotics or a rash that has lasted several days. A doctor can confirm it by looking at it and recommend a suitable antifungal cream.
What is the best cream for nappy rash?
For ordinary nappy rash, a fragrance-free barrier cream containing zinc oxide, or plain petroleum jelly, works well. The key is to apply a thick layer at every change. Medicated creams such as antifungals or mild steroids are only needed for specific types of rash, and should be used on the advice of a doctor or pharmacist.
Can I use baby wipes when my baby has nappy rash?
It is better to avoid them while the rash is active. Wipes can sting broken skin and some contain fragrance or preservatives that irritate it. Clean with lukewarm water on cotton wool or a soft cloth instead, and pat dry. If you need wipes when out, choose alcohol-free, fragrance-free ones and switch back to water at home.
Should I use baby powder for nappy rash?
No. Talcum powder does not treat nappy rash, can clump in skin folds, and can be breathed in by your baby, which may irritate the lungs. A barrier cream protects the skin far better. Keep powders away from the nappy area altogether, even when the skin looks healthy, and keep the area dry with frequent changes instead.
Can diarrhoea cause nappy rash?
Yes. Frequent loose stools are one of the most common triggers, because stool enzymes irritate the skin and the area stays wet. During diarrhoea, change the nappy as soon as it is soiled, rinse with water and use extra barrier cream. Also watch your baby closely for signs of dehydration, such as fewer wet nappies, and seek help if they appear.
Medically reviewed by Dr Nisa Khalil on 19 October 2026. This article is general information and does not replace a consultation with your own doctor.
References
American Academy of Pediatrics, HealthyChildren.org. Diaper rash. healthychildren.org
The Royal Children's Hospital Melbourne. Kids Health Info: Nappy rash. rch.org.au
NHS. Nappy rash. nhs.uk
National Institute for Health and Care Excellence. Clinical Knowledge Summaries: Nappy rash. cks.nice.org.uk
Worried about your child?
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