Nappy rash (1)

Question 1

What is this?

What is it usually caused by?

What can it lead to?

What are its complications?

Answer 1

➊ Contact dermatitis in the nappy area

➋ Friction and contact with urine and faeces

➌ Skin breakdown and moist environment → Infection

➍ • Candida infection
• Cellulitis
• Jacquet’s erosive diaper dermatitis

Question 2

What are its risk factors?

Answer 2

• Delayed nappy changing
• Irritant soap products and vigorous cleaning
• Poorly absorbent nappies
• Diarrhoea
• Oral Abx, which increases the risk of candida infection
• Premature infants

Question 3

How does it present?

What is a common finding here?
→ Which signs would indicate this?

Answer 3

➊ • Sore, red, inflamed patches of skin in nappy area
• Skin creases are usually spared
• May be itchy
• Long-standing rash can lead to erosions and ulceration

➋ Candida infection
→ • 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
• Oral thrush

Question 4

How is it managed?

Answer 4

• 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