The nappy areas are also predisposed to the development of fungal and bacterial infections, encouraged by the warmth and dampness of these areas, which facilitate the multiplication of pathogens and the spread of infection. The development of inflammation is encouraged by tight clothing and nappies, especially in warm seasons of the year, leading to moisture retention and overheating of the nappy area, and combined with long intervals between nappy changes, a factor that predisposes to dermatitis. The formation or exacerbation of lesions in the nappy area is observed in the course of gastrointestinal infections, urinary tract infections and antibiotic therapy. It is associated with an increase in the number of loose, acidic stools passed by the child and the presence in the urine and stool of bacteria producing ammonia that irritates the skin. New foods introduced into the baby's diet that change the consistency and quantity of stools can be a factor in causing nappy rash, and breastfed infants may react with gastrointestinal dysfunction to products consumed by the mother [1,2,3,4,5,7,8,9,10,11,12,13].

The primary goal of care is to prevent irritation, damage to the skin and to maintain proper skin hydration and ph, making the skin more resistant to damaging factors. In the prevention of nappy rash, the most important thing is to keep the skin clean and dry. This is achieved by daily bathing in warm water at 37-37.^50C, with mild soaps, synthetic detergents, free of fragrances, dyes and preservatives, with a neutral or slightly acidic ph. It is not advisable to wash the baby with water alone, as this dries the skin and increases the risk of skin damage. The skin should be dried with a soft cotton towel, without rubbing, or allowed to dry naturally. These procedures do not irritate the baby's delicate skin, do not destroy the protective lipid mantle, and allow the normal bacterial flora to be maintained, protecting against damage and the development of inflammation [3,6,7,9,10,11,12,13]. In newborns and infants, nappies should be changed every 3-4 hours and immediately after any soiling with urine and faeces.

The nappy area should be washed at every nappy change, dried thoroughly, and scented and alcohol-saturated wipes should not be used, as the agents they contain damage the epidermal barrier. Gentle moisturisers can be used to create a protective barrier between the skin and the nappy. Powders, powders, pastes and combinations with oils are not recommended for daily nappy care, as they can clump and damage the skin, and the tight adhesion of these products to the skin's surface makes them impermeable to air and causes irritation. Lotions are also not recommended as they can be an irritant to the skin.

Preparations in the form of creams are preferred, which dry the skin delicately, are air-permeable and usually also contain antiseptic, astringent and protective agents. In the prevention of nappy rash, it is important not to use plastic or rubber underpants and to use disposable nappies which are highly absorbent, have air-permeable micropores and are coated on the inside with skin moisturisers and lubricants to minimise the risk of irritation. The nappies should also be changed at night and not wait until the morning or until the baby wakes up. It is important to ventilate the nappy area. Leave the baby without a nappy at least three times a day for 10 minutes at a time, as airing promotes skin regeneration.

photo: Sudocrem

It is recommended to use larger nappies, as tight nappies cause overheating and moisture retention, creating good conditions for irritation and the onset of nappy rash [6,9,10,11,12,13]. Breast milk strengthens the infant's immunity and protects against infections, including skin infections, and therefore mothers should be encouraged to feed their infants this way. New foods should be added one at a time at intervals of several days, especially fruit juices containing acids that, when excreted in the stool, irritate the skin and predispose to inflammation.