Pamela
The baby with severe nappy rash might have a skin problem such as
psoriasis or seborrhoeic dermatitis. They both look different in the
nappy area compared to how we see them on other parts of the body,
and are often mistaken for thrush or ammoniacal rash. I agree with
other lactnetters that reaction to disposable nappies, lotions and
potions (including the cream the mother is using on the rash) can
make matters worse.
I also saw a mother recently who was using various types of
artificial milk to try to clear her baby's terrible nappy rash
(having weaned because her doctor told her the rash was due to
lactose intolerance AAAARGH). The rash resolved during an overseas
holiday, but was back once they returned home. Using cows milk and
soy based stuff didn't help. Eventually, she had her domestic water
supply checked, as she thought it tased funny, and was told the
copper level in it was too high. She switched to bottled water and
baby's rash vanished very rapidly. Change back to tap water caused
the rash to return.
Food for thought!

Fiona Coombes MBBS IBCLC               [log in to unmask]
Lactation Consultant, Family Physician
Perth Western Australia