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ive found metanium to be excellent for even horrendous doses of nappy rash etc, but it does sound nasty and could be thrush, i would take him to the gp, if all other methods fail(leave his nappy off etc)
I would take him to the GP, my ds had bad nappy rash and for some dippy reason i assumed the GP could not help. It went on for too long and he was sore, within a week of seeing GP he was better, and in retrospect feel bad he was uncomfortable for so long but thought it would heal up. It turned out to be thrush.
I kept his nappy of loads and put GP cream on. Always use barrier cream now and the ones that worked help ds are benthanpam, sudocrem and willeda's nappy area calendula cream. hope it gets better know what a worry it is.
My boy had something similar when he was smaller and they thought it may be a kind of boil, kept an eye on it and lots of nappy off time, more regular changes etc until it cleared, we didnt need antibiotics but it was suggested if it didnt clear on its own.