The delicate skin of a baby's buttocks is often covered in diapers for extended periods, which can often cause diaper rash. While in mild cases symptoms are limited to erythema and rashes, severe cases can cause vesicles, oozing, and even ulceration. To minimise occurrences parents may apply nappy creams to their babies. The Consumer Council reviewed label information on 16 nappy cream models on the market and found that 14 had an ingredient list, while 1 supplemented ingredient information upon the Council’s inquiry. 75% of the products (12 models) were found to contain 1 to 2 categories of ingredients of concern, including fragrances and fragrance allergens, essential oils or plant extracts that may contain terpenes, preservatives, or propylene glycol. All these may cause irritation or allergic reactions, worsen diaper rash, or even lead to adverse neurologic effects. As the relevant models did not specify the concentrations of the ingredients of concern, the Council could not assess the allergenic and other risks posed by those models. Regarding active ingredients commonly used in nappy creams, 12 products were labelled as containing zinc oxide, known for its antibacterial and anti-inflammatory properties, making it the most prevalent active ingredient among the surveyed products. However, only 4 products labelled their concentration of zinc oxide, all within levels specified by the U.S. Food and Drug Administration (FDA) for the prevention and treatment of diaper rash. The Council urges manufacturers to improve product labelling by clearly listing all ingredients and, where feasible, the concentration of relevant ingredients or substances to help concerned parents get enough information to assess risks. Manufacturers should also keep track of the latest international regulations to improve product formulations, thereby reducing the likelihood of allergic reactions in babies.
The Council purchased 16 nappy creams commonly available on the market with prices between $52 to $218 per container. Based on a 3-month-old baby’s daily usage (1.34g), average daily cost ranged from $0.56 to $7.3. Apart from 1 model which did not state intended users, all others claimed to be suitable for use on infants, of which 8 emphasised suitability for newborns. Additionally, 3 products also claimed to be suitable for adults, individuals of all ages, or the elderly who need to use adult diapers for extended periods.
Be Mindful of Selecting Products with Fragrance Allergens and Certain Essential Oils to Prevent Adverse Effects on Babies
Diaper rash (also known as diaper dermatitis) is an inflammatory skin condition that occurs in diaper areas such as the vulva, perineum, and buttocks. Nappy creams generally could alleviate skin irritation caused by diaper rash or serve as a physical barrier to prevent contact between body waste and the skin. Some products also claim to have skin-repairing properties. However, if nappy creams contain ingredients of concern such as fragrances and fragrance allergens, certain essential oil ingredients, or preservatives, they are more likely to irritate the skin, pose allergy risks or may even cause adverse neurologic effects. Fragrances and fragrance allergens can cause allergic contact dermatitis, and frequent or repeated exposure to products containing fragrances could increase the chance of allergic reactions. Infants, having thinner skin and a higher body surface area-to-body weight ratio, are particularly susceptible to allergic reactions after excessive and prolonged exposure to fragrance allergens, which may aggravate issues such as diaper rash. The survey found that 75% of the models (12 models) contained these ingredients of concern, with fragrances and/or fragrance allergens being the most common as 7 products were labelled as containing them, with the highest amount found in 1 product containing up to 6 types of fragrance allergens.
Additionally, 4 products were labelled as containing essential oils or plant extracts including lavender, rosemary, or salvia, but none indicated their concentrations. These essential oils or plant extracts may contain terpenes such as camphor, eucalyptol, or menthol, which could potentially cause undesirable effects in infants. A 2023 guideline by the European Directorate for the Quality of Medicines & HealthCare (EDQM) on safe cosmetics for young children highlighted that infants might experience adverse neurologic effects such as convulsions after using topical products containing terpenes, and quoted recommendation that such substances should be avoided in personal care products for infants.
2 Models Labelled with Preservatives Restricted Overseas for Infant Products
Regarding preservatives, 2 models were labelled as containing phenoxyethanol and methylparaben. The U.S. FDA had warned the public that phenoxyethanol in 1 nipple care cream may be ingested by infants through breast feeding and could affect the central nervous system, leading to vomiting, diarrhoea, and even dehydration. The French National Agency for Medicines and Health Products Safety (ANSM) further stated that products used in the diaper area for infants should not contain phenoxyethanol. Some paraben preservatives are potential endocrine disruptors, and posing a risk of sensitisation, they should be avoided, especially on broken skin.
Furthermore, 2 models were labelled as containing propylene glycol, which could be used as a skin conditioning agent, humectant, solvent, and fragrance ingredient. A Polish study indicated that propylene glycol frequently causes irritant contact dermatitis in young children and recommended that products with this ingredient should not be used on children under 2 years old.
Zinc Oxide the Most Common Active Ingredient
Certain Active Ingredients May Cause Allergic Reactions
With reference to U.S. FDA monograph specifying concentration requirements for active ingredients in the prevention and treatment of diaper rash, the Council examined the active ingredients of the models and found 13 labelled as containing 1 to 4 types of FDA-approved active ingredients, including zinc oxide, petrolatum and mineral oil, lanolin, etc. with zinc oxide being the most common, as 12 models claimed to contain this ingredient. Zinc oxide in nappy creams could help block urine and faeces from contact with skin, absorb moisture, and keep the skin dry, while also having antibacterial and anti-inflammatory properties. According to U.S. FDA, zinc oxide concentration in over-the-counter skin protectants should be between 1% to 40%. The survey found that only 4 models labelled their concentration, while another 4 supplemented information upon the Council’s inquiry. The zinc oxide content in these 8 products ranged from 1% to 20%, all within the FDA’s specified allowance. However, the remaining 4 models did not provide any information on their concentration, making evaluation impossible. Significant improvement in labelling is needed.
4 models were labelled as containing lanolin as an active ingredient. Lanolin possesses emollient, lubrication, and occlusiveness properties, making it effective as a barrier against irritants that cause diaper rash. However, it may also cause adverse reactions in some individuals with broken or sensitive skin. Lanolin was even named the “Contact Allergen of the Year” by the American Contact Dermatitis Society (ACDS) in 2023, and U.S. FDA has specified that lanolin’s concentration for the treatment and prevention of diaper rash should be 15.5%. Among the surveyed models, 2 provided information on lanolin concentration, either on the label or after the Council’s inquiry, with concentration ranging from 3% to 6%. 4 models were labelled as containing mineral oil, known for its good barrier properties, but none labelled the concentration.
Moreover, among the 16 models, 3 were labelled as containing natural plant ingredients, with calendula being more common, followed by sunflower seed oil. Although consumers generally perceive products with natural plant ingredients as safer and more reassuring, some individuals may have allergic reactions to certain natural ingredients, potentially leading to contact dermatitis in severe cases. Thus natural ingredients are not necessarily suitable for everyone.
Active Ingredients Not Fully Listed in Most Models
Improvement in Labelling Urged
Information on product ingredients and their related concentrations is crucial for consumers to make informed choices. However, 1 model only provided information on some of its ingredients, while another 1 only listed its active ingredients. Most of the remaining products were labelled with an ingredient list, but the majority failed to provide complete data on active ingredients and their concentrations.
It is noteworthy that, since all 12 models containing ingredients of concern did not specify the concentrations, the Council could not assess whether they complied with the limits set by relevant international regulations. Furthermore, 1 model had no indication on its expiry date. The Council urges manufacturers to clearly list detailed product ingredients and, where feasible, indicate the concentrations of relevant ingredients or substances. Additionally, they should keep abreast of the latest international regulations and recommendations to improve product formula and labelling information. The Council also hopes that regulatory authorities could make reference to other regions in establishing more comprehensive regulations on the safety and labelling of nappy creams to protect the delicate skin of infants.
When purchasing and using nappy creams, consumers can refer to the following:
- Reduce or avoid using products containing highly allergenic, irritating, or other harmful substances. Extra care should be taken for infants with broken skin, eczema, or sensitive skin;
- Before use, do a patch test by applying a small amount of cream onto a small area at the buttocks. If redness, itching, or other discomfort occurs, rinse off immediately and discontinue use;
- For mild diaper rash, use a nappy cream with zinc oxide. If there is no improvement after a few days, or if blisters, pus-filled bumps, bleeding, ulcers, expanding redness, or fever occur, consult a doctor immediately;
- Put the cap back on the nappy cream immediately after each use to prevent product deterioration or microbial contamination. Store it in a cool, dry place away from direct sunlight;
- Be mindful of the production date, expiry date, and period after opening. Stop using if the product changes colour;
- Some parents may use talcum powder against diaper rash in infants, but when mixed with urine or sweat, it may clog pores and increase friction on the skin, potentially leading to diaper rash or worsening existing rash. In addition, if used improperly the fine particles of talcum powder could irritate the trachea or lungs. Therefore, its use against diaper rash is not recommended.
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