When ‘nappy rash’ is really the sign of an allergy
Baby wipes, cleaning sprays and even potty training seats could all be to blame
Like every mum, i was looking forward to getting my daughter potty trained. With another baby on the way, i was keen to avoid lugging around two lots of nappies, and Daphne, then two, was showing all the right signs.
i stocked up on Peppa Pig pants, a potty, a book about princesses’ potties (obviously) and a spongy plastic seat to make our bathroom toilet more comfy.
But weeks into the process — sadly, it wasn’t the two-day task promised by the experts — i noticed a red rash on her bottom. i assumed it must be nappy rash, where the skin is irritated by urine and faeces in a nappy, which she was still wearing at night.
i thought it was odd, though, because she had never really suffered with it before and now had a nappy on a lot less.
Nonetheless, i tried out a regular cream, but it had no effect and after a few days, with her skin hot and itchy, i took her to the first of five appointments at our GP surgery in Bromley, kent.
We were told it could be an infected nappy rash, a viral rash, even Henoch-Schonlein Purpura — inflammation of the blood vessels. Steroid and antibiotic creams were prescribed but none could shift it.
The location of the rash (back of legs and bottom) prompted questions about whether we used harsh cleaning products on the potty — we didn’t.
Finally, on our fifth visit, the GP referred us to a dermatologist and said we should hear from them in a couple of weeks. Meanwhile, the rash was spreading and getting angrier; Daphne was getting more agitated. At one point, it seemed to trigger a hives-like rash on her back and face. With a two-month-old baby and a toddler who was finding it painful to sit down, i started to panic.
One morning, Daphne woke up and her pyjamas and sheets were stained with blood because she’d been scratching all night. it was the final straw — we took her to the children’s A&e department at king’s College hospital in South London, where we saw a dermatology registrar. She couldn’t tell us the cause but said it was a chronic outbreak of eczema, and prescribed a potent steroid cream not normally given to children, but deemed necessary in Daphne’s case to bring the skin back under control.
To our great relief, the cream started to work, and we went to Florida for a two-week holiday. Applying the cream twice a day, combined with sun and sea water, meant that her skin was almost clear by the time we returned home. But within 48 hours, the rash was back.
That’s when i realised it had to be something her skin was in contact with at home. i did some internet research and found forums and message boards on which other parents were complaining of skin reactions to the WeePOD — the bright pink squidgy seat topper i’d bought to make our big toilet less daunting.
THE posts all talked about the same thing — ‘ horrible eczema-type rash . . . itchy, blotchy red, swollen bumps on the backs of his little legs . . . the rash got much worse and is basically everywhere the seat touches’.
it was horrifying reading but also quite comforting — finally, we had found a potential source of the problem.
in a makeshift experiment, i took the seat away. The rash disappeared within days, never to return. i’m convinced the WeePOD prompted allergic contact dermatitis in Daphne. When i contacted WeePOD’s maufacturers, Prince Lionheart, i was told: ‘Some of our potty seats are crafted with non-toxic foam. Some individuals may have a skin sensitivity to the material we use but the number of reports of minor skin irritation are minuscule — less than .0027 per cent of the units that have been put in use.
‘We take child safety and comfort very seriously. Our potty seats have been subjected to rigorous third-party testing to ensure safety and compliance to worldwide testing standards.’
Dr Matthew Zirwas, director of the Contact Dermatitis Centre at Ohio State University, says he has seen reactions to trainer seats before.
‘Most regular seats are made out of hard, inert plastic — it’s extremely rare for people to be allergic to hard plastic. But as soon as you get into softer plastic materials, rubbers or vinyls, it certainly happens. it’s uncommon but i’ve seen it.’
Dr David Orton, a dermatologist at Hillingdon Hospitals NHS Trust and spokesperson for the British Association of Dermatologists, agrees that allergies to plastics are rare, and most eczema in the nappy area is usually nappy rash and not an allergy.
‘But if the usual creams aren’t settling the problem, it should always cross the doctor’s mind that there could be an allergic component,’ he says. ‘And if it’s a chronic case that’s not responding as they would expect, they should refer the patient ideally to a dermatologist with an interest in allergy.’
One potential culprit is wet wipes. Some contain a preservative called methylisothiazolinone or Mi, recently found to trigger skin reactions.
‘ We’ve recently seen an epidemic of allergic contact dermatitis among children and adults to Mi,’ says Dr Orton.
‘it will look like eczema — red and inflamed, there may be blisters, there will be swelling and scaling of the skin and it will be itchy.’
Huggies was just one of a number of major wipes brands that contained Mi. in 2013, after soaring numbers of skin outbreaks, Cosmetics europe — the professional body that regulates the european cosmetics industry — ruled that Mi should be removed from products as soon as possible, but Dr Orton says it took time.
‘This wasn’t legislation, it was a suggestion, so even though it’s no longer in Huggies, it could still be present in smaller brands of wipes,’ he explains.
‘Some wipes also contain fragrances which babies and toddlers can be allergic to, or if they already have inflamed skin, then fragrance can irritate it. Look out for words on the label like “fragrance”, “parfum” and “aroma”. ‘ if those words are there, there are fragrance chemicals in it.’ He says that parents should also be wary of the marketing term ‘hypoallergenic’.
‘it should mean less likely to cause allergy — i. e. the formulation should try to avoid using recognised allergens, but there is no enforcement of this or exact definition of this that manufacturers have to comply with.’
if you suspect an allergy, switch to a flannel or cotton wool and water straight away.
Nappy rash could also, very rarely, turn out to be an allergic reaction to the nappy itself.
‘You might get what we call “mechanical dermatitis”, where a nappy is rubbing or from the sticky tape, but neither of these would be a true allergic reaction,’ says Dr Orton.
NAPPY rash is typically on the buttocks, genitals and thighs, whereas mechanical dermatitis would be all over the nappy area, particularly where the nappy meets the skin.
Finally, parents should be mindful of what they’re using to clean changing mats.
Dr Zirwas says: ‘We often see an allergic reaction to whatever is being used to clean toilet seats or changing mats.
‘if cleaning wipes or spray cleaner are used and the area isn’t rinsed afterwards, you leave behind residual chemicals that can cause a reaction.’
The most common allergens to look out for are Mi, limonene, linalool and surfactants.
Meanwhile, Daphne takes pride in using a ‘big girl’s toilet’ — no extra seat required.