Stubborn severe nappy rash! Nothing works..

[Trinacham]

Wondering if anyone else has had this issue as feel so alone in this. It seems like most people have luck with just simply applying Metanium cream and after a couple of days it's gone. No such luck here. Here's what we've tried so far...

Sudocream

Metanium

Went to doctor after neither of these made any difference.
Doctor prescribed an anti-fungal+steroid cream to be used for 7 days. After I put the steroid cream on, I apply Metanium to act as a barrier, on doctor's advice

After 3 days I went back to doctor as it was worse than before
Doctor now prescribed just a steroid (I can only use this for a further 4 days as can't exceed 7 days with the steroid use) and I've now cut out dairy (I'm EBF) as we think baby may have an intolerance (he had a very watery poo today)

This brings us to today, where I'm starting this thread. Rash is still here after 2 days and I can't see any improvement. We have to stop using it on Friday so there should surely be a noticeable difference by now.

Other points
Baby has very regular bowel movements - think this plays a major part in why it is so stubborn, the skin doesn't have much chance to be dry and heal before the next bowel movement

I do nappy free time as much as possible, as long as he's in a happy mood (sometimes just cries and screams when nappy is off)

Using pampers. The sore area is confined to his bottom, groin area is fine and all creases are fine, so almost certain it isn't a reaction to the nappy. The sore area is only where his poo touches, which leads us to believe he has an intolerance and the poo is burning his skin.

We use only warm water and cotton wool, no wipes.

Any help and advice, or just anyone who has been through this, would be great to hear. Baby is only a month old and he's had this for over a week now. He doesn't appear too bothered but it looks so sore. Hoping it doesn't feel as sore as it looks. If even steroid cream doesn't work, I'm wondering what else the doctor can do. Feel like the options are running out and it's worrying me.

Bepanthen worked for us.

How old is he ? Teething can give a sore bum.

Our little girl had issues with very frequent poos and terrible nappy rash in her early weeks. For her it was her formula that wasn't agreeing with her, once we swapped from cow & gate to hipp organic it stopped.

Just think if other things don't work look at your diet again to see if anything else there needs cutting out.

Sunlight or the light from an ordinary light-bulb.
Washing with lukewarm water and cotton wool - great. Do it every nappy change (2 hourly). A tiny amount of salt in the water, not enough to sting.
At home, no nappy. Bum bare to the air.
I'd worry that cornflour would act like talcum powder, clogging and forming little stones.

Try a different nappy brand? My daughter had persistent nappy rash early on, initially we put this down to how often she was having a poo, but our health visitor recommend trying a different nappy brand and this cleared it up!

We were initially using pampers, which she had the reaction to, and have now moved to boots own and their little stories bamboo nappies.

My DD had this and it ended up being an intolerance to the formula milk I was using. When I changed brands it resolved itself. Not sure if this is a possibility?

I use a sponge to wash baby's bottom with most nappy changes (when at home), then dab dry and apply baby talc (It's cornflour not talc). Seems to help.

A thick layer if bepanthen with a layer of Vaseline on top. Metanium made it worse for my dd, the dr we saw didn’t rate it as it’s drying and drags the skin making it worse. The bepanthen/Vaseline combo was recommended by a hospital as the nappy rash was so severe, and it became my go to for all 3 dc.

With dd a really thick layer of zinc and castor oil cream was the only thing that worked. I tried metanium, sudocream etc.
It was especially bad during teething poor little sausage.

@Skyla01

I didn't find metanium any help, but bepanthen cream was much better and cleared up rash.

I found the same, metanium often made it worse but it cleared up in a day with bepanthen.

Apparently thrush can cause nappy rash that won't budge - have you treated for that?

Also it's worth trying another brand of nappies, my Son seemed to have nappy rash a lot with Pampers but like you describe it wasn't all over so didn't think it was the nappies but it made a big difference. We use Morrison's own or Sainsbury's own.

Plenty of nappy free time, try to do it at nap times if he just screams or as soon as he's up from a sleep so he's hopefully in a good mood! You can also do it while you're feeding just have a towel underneath just incase.

If that still doesn't work then I'd definitely be back on at the doctor

Desitin is an American brand akin to Sudocrem but infinitely superior. There nothing we haven’t used it on and nothing it hasn’t cleared. The zinc content is very high. Perhaps that the key to its magic.
You’ll be able to get some from eBay or Amazon.

I’d also change the nappies. Perhaps to kit & Kin

Not sure if anyone has mentioned already but the Breastfeeding network recommend cutting out eggs as well if your baby has CMPA. We eventually found this out after months of severe nappy rash just like you describe (and eczema elsewhere) and within days of stopping eggs it was clearing up.
I totally feel for you - bad skin in babies is horrid and you feel like you're going round in circles! You will get there. If it doesn't clear up just keep booking weekly appointments with your GP until it's sorted.

I'm only halfway through the answers so this might have been mentioned - if you're breastfeeding, breast milk on the rash might help.

Can you write down the name of the creams you were prescribed by the doctor?

The best one ive found is timodine alternated with metanium.

Also maybe change the nappies . Aldi are really good.

My son rarely gets nappy rash but when he does I find the creams useless.

I find using water wipes/water and cotton wool to clean and pat fry with a muslin and regular changing works best for us.

Only to say, years ago I read an nhs tip to do nappy off time at night because they move around less. This helped a lot for us. Yes it's a bit grim but you can get cot liners/pads for bed setters that you can Chuck and you get more nappy off potential at night.

Of course, if it stops them sleeping it's no use.

I found Weleda calendula nappy cream with metanium on top always worked brilliantly when it’s really bad. I’ve suggested this to a few others and they’ve always been amazed at how well it worked.

Completely wash and dry the area. I'm not talking a wipe with a wet wipe and a pat dry, but using warm soapy water then plain water and then a hair dryer on a low warm setting. Completely dry the area out.

Bepanthen doesn't cover wounds well and can leave gaps but I'd apply this first as it's a good product then the big barrier of petroleum jelly on top. You'll be using a spoonful at a time. Soften it by rubbing in your hands before applying.

The only way to break the cycle is to dry completely and barrier up the old fashioned way.

If there are any digestive issues or teething the faeces will start to dissolve skin. You are into wound management rather than nappy rash if it gets severe.

Olive oil dropped in warm water then clean with cotton wool , fantastic for getting rid of nappy rash

I see you are already doing the warm water and cotton wool. I always used to finish off with the pink lotion by Johnson to act as a mild moisturising barrier and that helped a lot, otherwise I put a thick layer of sudocream on (and washed off/reapplied) each nappy change) Try a different brand of nappies too

Medihoney worked for my son once the thrush had been treated. You have to ask for it at the pharmacy.

I found regularly bathing got rid of DS’s nappy rash. That’s the only way we can avoid it with him

Thanks all. Bit overwhelmed by how many different tips! I didn't want to rush into any of them in case it made matters worse as some of them do go against what I've been advised and conflict with what's said on various websites (ie. Dr recommended to use pampers, I was using aldi's when rash started, disposables are recommended when there's a rash present).
The rash is still visible but does seem to have healed a lot, I think it's on its way out. I'm bathing baby twice a week now (was once weekly), and he's having hours of nappy off time at each change in the day.. seems to have gotten used to this and doesn't get upset (I place a towel on myself to catch any wees and poos!). It seems to be slow to heal but there's definitely improvement and he doesn't seem to be feeling any discomfort.