Your Baby’s Skin, Preventing and Treating Nappy Rash Information for Parents and Carers
Index
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The Skin
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Your Baby’s Skin
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Nappy Associated Dermatitis (NAD)
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Cleaning the Skin
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Use of Skin Barrier Products
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Step Up - Step Down
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Other Causes of Skin Damage
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Further information
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References
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The Skin
The skin is one of the most important organs of the body. It protects us from the outside world, helps to regulate our temperature and respond to changes in the environment 1 .
The skin has three layers which enable it to be the protective barrier we need.
Top layer (Barrier)
The Epidermis
Second layer (Containing the blood supply, connective tissue and nerves)
The Dermis
Bottom layer (Formed of fat cells providing insulation and protection)
The Hypodermis
Source of image 8
Your Baby’s Skin
The skin starts to develop quickly following conception and is usually fully formed at birth; however, it is only 60% the thickness of adult skin, it is immature and is at risk of damage from moisture, pressure, irritants, and infection.
Factors which increase the risk of damage to your child's skin include 3 :
The feel of the skin of newborn babies settles and softens during the rst few weeks of life.
Skin Texture
Water evaporates through the skin of babies much faster than it does in adults. This is called trans-epidermal water loss. Newborn babies can lose up to 30% of their body weight through water loss. See the diagram on the next page.
Trans-Epidermal Water Loss
At birth the skin is more alkaline as there is less natural moisturiser present on the surface. The acid mantle that protects the skin is not fully functioning.
Changes in the Skin’s pH
The joint between the top two layers of the skin (the epidermis and the dermis) is called the epidermal/dermal junction, it is weaker in babies.
The Epidermal/ Dermal junction
The Skin is in a State of Flux
The skin of babies is in a state of ux as it adapts to the outside world.
Trans-Epidermal Water Loss
Source of image 7
All this means is that in infants the skin’s ability to function as a barrier is limited, and the skin is susceptible to damage including:
Blistering Skin stripping and tearing Maceration or wet, soggy skin particularly in skin folds Allergic reaction to topical preparations Infection Contact dermatitis Nappy Associated Dermatitis (NAD) or nappy rash
Good skin care can help reduce these problems and ensure your baby’s skin remains healthy. One of the biggest challenges parents face is Napkin Associated Dermatitis (NAD) also called Nappy Associated Dermatitis.
Nappy Associated Dermatitis (NAD)
NAD is one of the most common skin problems, a ecting up to a quarter of babies. It is a form of contact dermatitis where the skin reacts to urine (wee) and faeces (poo) sitting between the nappy and the skin’s surface 5,6 . The skin becomes in amed, it is hot to touch, may be swollen and feel rm. It will change colour, appearing reddened in light skin or purple in dark skin. The severity of skin damage can vary, (See Table 1) this is dependent upon how long the skin is exposed to moisture. It is also in uenced by several other factors including 2 :
Exposure to irritants (on next page)
Type and size of nappy
Nappy-free time
Frequency of nappy changes
Type of skin cleanser
Frequency of skin cleansing
Barrier cream or lm used to protect the skin
Irritants Contributing to NAD
• Urine • Faeces • Perfumes • Essential oils
• Recent diarrhoea • Alcohol (in baby wipes and cleansers) • Talcum powder • Detergents
Table 1: Severity of NAD 4
No skin changes
Broken skin, spots, swelling signi cant skin loss & spreading in ammation
Moderate rash on >10% of the area, spots, swelling & breakdown of the skin with bleeding
Rash <10% of the nappy area, spots, dryness, or scaling
Unbroken Skin
Moderate Skin Damage Moderate erythema + small areas of damaged skin (<50% of a ected area)
Severe Skin Damage Intense erythema + large areas of damaged skin (>50% of a ected area)
Mild Skin Damage Unbroken skin
Unbroken skin at risk of skin damage
with mild erythema
(redness on white skin) +/- irritation
Good skin care is the rst step in preventing NAD. Using nappies that have high absorbency rates and changing the nappy as frequently as possible after soiling can help. Preventing NAD
Cleaning the Skin
Avoid skin cleansers that contain perfumes and alcohol as they have a drying e ect. Soap can also dry the skin and should always be avoided. Water is a good solution for the skin; When a cleanser is required, use MEDI DERMA PRO Foam & Spray Incontinence Cleanser (see below). If using baby wipes, ensure they don’t contain perfumes and alcohol. These cleansers can break down the acid mantle and cause stinging if the skin is broken. Ensure all visible matter is gently removed from the skin’s surface. Dry carefully to avoid damaging the top layers of the skin and pat dry rather than rubbing the skin. The skin can also be left to air dry. Nappy-free time allows the skin to recover and is comfortable for your child.
Use of Skin Barrier Products
Mild Skin Damage Moderate Skin Damage Severe Skin Damage
MEDI DERMA S Total Barrier Cream
MEDI DERMA S Total Barrier Film
MEDI DERMA PRO Ointment & Cleanser
Skin barrier products may be needed when the skin is at risk of damage or when there is evidence of mild, moderate, or severe NAD . They are designed to prevent and treat skin damage. They provide a water-repellent barrier, preventing urine and faeces from coming into contact with the vulnerable skin.
There are many barrier products available; to be e ective a skin barrier should:
Form an e ective protection barrier
Be easily removed
Not cause pain or discomfort on application
Not clog up nappies, allowing urine and faeces to be easily absorbed
Be supported by clinical evidence
When your child is unwell, they are at greater risk of skin damage. For this reason the nurses caring for them may recommend Medicareplus skin barrier products that form a silicone barrier over the skin. They are easy to apply and form an e ective barrier protecting your child's skin from NAD. Your child may be prescribed a barrier cream, barrier lm or cleanser and ointment. The product chosen is dependent upon your child’s needs and the severity of skin damage.
MEDI DERMA-S TOTAL BARRIER CREAM
MEDI DERMA-S Total Barrier Cream is designed to protect the skin from skin damage and treat mild NAD. It creates an invisible barrier on the skin that allows you to see the skin’s surface below. It is available in 2g sachets, 28g tubes or 90g tubes. Your healthcare professional will provide you with the best solution for your child.
How to apply
MEDI DERMA-S Total Barrier Cream provides a barrier that will last for up to12 hours so you only need to apply it in the morning and at bedtime.
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Step 1: Skin Preparation: Clean and dry the skin. •
Step 2: Application:
Step 3: Quantity to Use:
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“Pea to palm” Apply a pea-sized amount of cream to an area the size of your palm. Apply gently in a circular motion or in the direction of hair growth. • •
Your skin should be clearly visible through the cream. If the skin appears oily, remove excess with a soft tissue/towel.
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A thin layer of the cream, a pea-sized amount, will provide a protective barrier over an area the size of the palm of your hand (remember pea-to-palm!). The cream will dry in about 30 seconds providing an e ective barrier on the skin surface.
MEDI DERMA-S TOTAL BARRIER FILM
MEDI DERMA-S Total Barrier Film also forms an invisible barrier and is suitable for mild to moderate skin damage.
It is available as a single use 1ml applicator, or a wipe. A 50ml aerosol or 30ml pump spray are also available. Your healthcare professional will select the best option for your child.
How to apply
Ensure the lm is fully dry after application; it provides long-lasting protection and it needs to be applied once daily.
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Step 1: Skin Preparation: Clean and dry the skin. •
Step 2: Application:
Step 3: Application: • If using an applicator or wipe, apply evenly to the a ected area. If using around a wound or stoma, apply to the surrounding skin. Ensure it is fully dry.
• Spray using an even sweeping motion holding the can 5cms for pump spray away from the skin and 10-15cms for aerosol. Ensure it is fully dry.
MEDI DERMA- PRO FOAM AND SPRAY INCONTINENCE CLEANSER AND MEDI DERMA- PRO SKIN PROTECTANT OINTMENT
MEDI DERMA PRO Foam and Spray Incontinence Cleanser and MEDI DERMA PRO Skin Protectant Ointment are designed to protect and heal severely damaged skin. They should be used together at each nappy change to ensure the skin is fully protected.
MEDI DERMA- PRO FOAM AND SPRAY INCONTINENCE CLEANSER:
MEDI DERMA PRO Incontinence Cleanser is used to clean the skin. It will remove any visible debris on the skin’s surface and any residual ointment. It can be applied directly to the skin or onto a soft cloth that is then dabbed onto the skin. It is available in a 250ml bottle with a front cap that can be opened to spray across the skin’s surface or closed to apply a foam onto speci c areas of the skin.
You do not need to rinse the skin and you do not have to remove all the cleanser prior to applying MEDI DERMA- PRO Ointment.
Always ensure all residual ointment and debris are removed.
How to apply
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4
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Step 2: • Apply directly to the skin or onto a wash cloth. • Can also be applied to a dry wipe and dabbed on the skin.
Step 3: • Gently clean the area. Try not to rub. No need to rinse.
Step 1: Turn nozzle to
Step 4: • Pat dry or leave to dry in the air if possible.
(1). • Foam Mode: Keep ap closed and pull lever. • Spray Mode: Open ap (2) and pull lever.
MEDI DERMA- PRO SKIN PROTECTANT OINTMENT
MEDI DERMA PRO Skin Protectant Ointment forms a barrier on the skin that protects damaged skin and prevents further damage caused by urine and faeces. The ointment will not block nappies allowing uid to be absorbed away and locked into the pad.
It has a non-sting formulation and will gently glide across intact and damaged skin providing a protective layer.
MEDI DERMA PRO Skin Protectant Ointment is available in 115g tubes, does not dry out and is designed to provide a moist barrier against the skin; this helps protect and hydrate the area and can help reduce pain.
Instructions
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Step 1: • Clean and dry the skin.
Step 4: • Clean the area and reapply after each episode of incontinence or when the skin no longer looks shiny.
Step 2:
Step 3:
• Gently apply a thin layer evenly over the a ected area. Apply more on very wet or damaged skin.
• If you have been given another treatment to use at the same time, let that product dry rst for 5 minutes, before applying MEDI DERMA- PRO Skin Protectant Ointment
Step Up – Step Down
Medicareplus International recommend taking a step-up, step-down approach to skin care. If your baby's skin deteriorates or improves, talk to your healthcare professional who will be able to advise you.
TOTAL BARRIER PROTECTION TM (TBP) APPROACH
Step Up If there is no significant improvement in the skin after 2-3 days
Step Down If there is noticeable improvement in the skin after 2-3 days
SKIN DAMAGE MODERATE
SKIN DAMAGE SEVERE
SKIN DAMAGE MILD
FILM FOR
OINTMENT FOR
CREAM FOR
SKIN DAMAGE METER
MEDI DERMA S Total Barrier Cream
MEDI DERMA S Total Barrier Film
MEDI DERMA PRO Skin Protectant Ointment and Foam & Spray Incontinence Cleanser
Other Causes of Skin Damage
Whilst NAD is very common, other problems can a ect your baby’s skin; these include pressure, infection and skin diseases such as eczema. If your baby’s skin does not improve or you are concerned always talk to your healthcare professional who will be able to help.
If you would like any further information, please visit the Medicareplus International website at www.medicareplus.co.uk and contact your GP or Pharmacist. Further information References 1. Beaumier A, Murray BA, Despatis MA, Patry J, Murphy C, Jin S O’Sullivan-Drombolis D (2021_ Skin: Anatomy and physiology of wound healing Wounds Canada. Available online: https://www.woundscanada.ca/doclink/bpr-brief-01-skin-physiology- 1971e- nal-individ/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWIiOiJicHItYnJpZWYtMDEtc2tpbi1waHlzaW9sb2d5LTE5 NzFlLWZpbmFsLWluZGl2aWQiLCJpYXQiOjE2MjczMTk0MzgsImV4cCI6MTYyNzQwNTgzOH0.zRyvocKD0m3WlcA-jK_kXBUsf IC5QVIofCcmUU8HKP4 Sourced 20/04/2021 2. Lawton S (2020) Nappy rash: current evidence for the prevention and management British Journal of Midwifery Vol 28. Available online: https://www.britishjournalofmidwifery.com/content/clinical-practice/nappy-rash-current-evidence-for- the-prevention-and-management/ 3. Leung A, Balaji S, Keswani SG (2013) Biology and functions of foetal and paediatric skin Facial Plastic Surgery Vol 21 No 1 pp 1-6. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654382/#:~:text=At%2024%20weeks%20 gestation%2C%20fetal,to%20reconstitute%20the%20dermal%20appendages. Sourced 20/04/2023 4. Huish S, Walters E (2020) Guide to the use of barrier protectants on neonatal and paediatric nappy rash. British Journal of Nursing MA Healthcare
5. NICE (2022) Nappy Rash. Available online: https://cks.nice.org.uk/topics/nappy-rash/
6. Ward BD, Fleischer BD, Feldman AB, Krowchuk DP (2000) Characterization of diaper dermatitis in the United States American Medical Association. Available online: https://jamanetwork.com/journals/jamapediatrics/fullarticle/350919 sourced 24/04/2023 7 . Source of image: From Blog ‘Hot Is Baby’s Skin Di erent From Ours?’ By marketing@eltean. Available online: https://www.eltean.com/adults-babys-skin/ 8. Source of image: Shutterstock (2003-2020) (Jpeg). Available at https://www.shutterstock.com
Medicareplus International is the skin protection specialist in wound care, continence care and stoma care. They support healthcare professionals to improve the outcomes for patients.
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Medicareplus International Limited Chemilines House | Alperton Lane | London | HA0 1DX | United Kingdom Telephone: +44 (0)20 8810 8811 | Email: info@medicareplus.co.uk www.medicareplus.co.uk
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