Hi Welcome to HCM Most cases of nappy rashes are due to a reaction of the skin to urine and poo (faeces, stools, or motions). Non response of your child to common nappy rash cream can be due to associated bacterial or fungal infection. A fungus called candida commonly thrives on the inflamed skin. (This is the germ that causes thrush.) Candida can cause a more inflamed rash which may include darker red spots spreading around the nappy area ( nappy thrush ). I would suggest creams having barrier properties along with anti fungal and anti bacterial properties. Also take following measures to prevent further damage; -Leave the nappy off as much as possible -Change nappy often. -Wipes are as effective as water. -After washing, make sure the baby s bottom is properly dry. -Do not use powder such as talcum powder. -Rub on a thin layer of barrier cream or ointment just before putting on each nappy. Do not apply too much, as this may reduce the breathability of the nappy. -Don t use tight-fitting plastic pants over nappies.