Canasten (anti-fungal cream) has worked for a really nasty nappy rash in the past, as has Betadine (which I used with sposies so I didn't stain cloth).
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I find if it's really bad I need to have a few hours until bedtime with liberal amounts of a good zinc based powder to create a bit of dryness and then I coat heavily with Nappy Goo (made by the children's hospital in Melb you can find stockists on the website) at the night nappy. This has helped me with some pretty bad ones.
HTH
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