Nappy rash

This is a type of contact dermatitis that affects the nappy area. It's usually caused by friction and contact with urine and faeces, which leads to skin breakdown and moist environment → Infection.

Complications of it are:

• Candida infection

• Cellulitis

• Jacquet’s erosive diaper dermatitis

Risk factors:

• Delayed nappy changing

• Irritant soap products

• Vigorous cleaning

• Poorly absorbent nappies

• Diarrhoea

• Oral Abx, which increases the risk of candida infection

• Prematurity

Presentation

• Sore, red, inflamed patches of skin in nappy area

  • Skin folds are usually spared!

• May be itchy

• Long-standing rash can lead to erosions and ulceration

A common finding here is Candida infection. This will present with:

• Rash extending into skin folds

• Larger red macules

• Well-demarcated scaly border

• Circular pattern to the rash, similar to ringworm

• Satellite lesions – smaller patches of rash/pustules near main rash

Management

• Simple measures can improve skin and treat the rash in a few rash:

  • Use highly absorbent nappies

  • Frequent changing on nappies once wet/soiled – Make sure nappy area is dry before replacing

  • Use water or gentle alcohol-free products

  • Maximise time not wearing a nappy

• Anti-fungal cream or Antibiotics if infection