Nappy Rash

Nappy Rash

Definition

• Inflammatory reaction of the skin in the nappy area, commonly seen in infants due to prolonged exposure to moisture and irritants

• Often presents as redness and irritation in the diaper region without systemic symptoms

____________________________________

Aetiology

• Overhydration: Prolonged contact with urine and faeces disrupts the skin barrier, causing irritation from ammonia

• Friction: Tight or ill-fitting nappies increase rubbing and mechanical irritation of the skin

• Irritants: Faecal enzymes, residual soaps and wipes contribute to barrier breakdown

• Candida overgrowth: Common in persistent or severe cases, leading to satellite pustules and plaques

• Additional factors: Poor nappy hygiene, infrequent changes, and the use of harsh cleaning agents

____________________________________

Presentation

• Redness and inflammation localized to the nappy area, typically affecting the buttocks, groin, and intertriginous zones

• Discomfort during nappy changes and possible ulceration in severe cases

• Associated symptoms may include post-feed irritability and signs of dehydration, such as fewer wet nappies and dark urine

• May be complicated by secondary Candida infection in prolonged or recurrent cases

____________________________________

Differential Diagnosis

• Candidal diaper dermatitis: Presents with bright red rash and satellite lesions, often requiring antifungal treatment

• Seborrhoeic dermatitis: Typically affects the scalp and face but may involve the diaper area in some infants

• Atopic dermatitis: Chronic, relapsing condition with a history of eczema and family history of atopy

• Psoriasis: Well-demarcated, scaly plaques that are less common in the nappy area

____________________________________

Management

• General measures:

  • Use absorbent disposable nappies and change them at least every 2 hours or immediately when soiled

  • Encourage nappy-free time to allow the skin to air-dry and recover

  • Avoid tight nappies to reduce friction and pressure

• Skincare and barrier protection:

  • Apply barrier creams such as zinc oxide or petroleum jelly generously to protect against irritants

  • Use soap-free, fragrance-free cleansers and wipes during nappy changes

  • Consider Epsom salt baths to soothe the skin in cases of widespread irritation

• Pharmacological treatment:

  • First-line therapy with a combination cream of hydrocortisone 1% and an antifungal (e.g. nystatin or miconazole) mixed with zinc oxide for inflammatory and candidal components

  • In refractory or severe cases, a higher potency topical steroid may be used under specialist advice

  • For ulcerated areas, use protective agents like Orabase with benzocaine for pain relief

• Preventive strategies:

  • Educate parents on correct nappy changing techniques and the importance of regular cleaning

  • Advise on proper use of barrier creams and avoidance of harsh soaps or wipes

  • Emphasise the role of hand hygiene during and after nappy changes

____________________________________

Notes

• Monitor for improvement; expect resolution with appropriate supportive care and preventive measures

• Reassure caregivers that nappy rash is typically self-limiting if managed correctly

• Consider underlying allergies or immune issues if rashes recur frequently or persist despite standard care

• Regular follow-up is important to assess response and adjust management as needed