flashcards_nappy_rash

Question 1

What self-management strategies should be advised to parents/carers for nappy rash?

Answer 1

Consider using a nappy with high absorbency and ensure that it fits properly, leave nappy off as much as possible, clean the skin and change the nappy every 3-4 hours or as soon as possible after wetting/soiling, use water or fragrance-free/alcohol-free baby wipes, dry gently after cleaning, bath the child daily but avoid excessive bathing, do not use soap, bubble bath, lotions, or talcum powder.

Question 2

What should be done if mild erythema is present and the child is asymptomatic?

Answer 2

Advise on the use of barrier preparation to protect the skin and apply thinly at each nappy change. Options: Zinc and Castor oil ointment BP, Metanium ointment, soft white paraffin BP ointment.

Question 3

What should be done if the rash appears inflamed and is causing discomfort?

Answer 3

If > 1 month = hydrocortisone 1% cream OD (max 7 days) + barrier cream. Advise to apply topical hydrocortisone first and wait a few minutes before applying barrier preparation.

Question 4

What should be done if the rash persists and candidal infection is suspected or confirmed on swab?

Answer 4

Advise against the use of barrier protection, prescribe topical imidazole cream (e.g. clotrimazole, econazole, miconazole).

Question 5

What should be done if the rash persists or bacterial infection is suspected or confirmed on swab?

Answer 5

Prescribe oral flucloxacillin for 7 days, or if penicillin allergy: clarithromycin (7 days).

Question 6

What is the summary of key management points for nappy rash?

Answer 6

Disposable nappies are better than towel nappies, expose nappy area to air where possible, apply barrier cream (e.g. Sudocrem), use mild steroid cream (e.g. 1% hydrocortisone) in severe cases, manage suspected candida nappy rash with topical imidazole (cease the use of barrier cream until candida has settled).