Nappy Rash

Question 1

Nappy Rash

Answer 1

Contact dermatitis in the nappy area

Question 2

Pathophysiology of nappy rash

Answer 2

Caused by friction between the skin and nappy and contact with urine and faeces in a dirty nappy

Question 3

Complication of nappy rash

Answer 3

Bacterial or fungal superinfection with candida or staphylococcus/ streptococcus

Erosions or ulceration if long standing

Cellulitis

Jacquet’s erosive diaper dermatitis

Perianal pseudoverrucous papules and nodules

Question 4

Risk factors for nappy rash

Answer 4

Delayed changing of nappies

Irritant soap products and vigorous cleaning

Certain types of nappies (poorly absorbent ones)

Diarrhoea

Oral antibiotics predispose to candida infection

Pre-term infants

Question 5

Presentation of nappy rash

Answer 5

Sore, red, inflamed skin in the nappy area

Spares skin creases

Question 6

Signs of a candida infection

Answer 6

Rash extending into the skin folds

Larger red macules

Well demarcated scaly border

Circular pattern to the rash spreading outwards, similar to ringworm

Satellite lesions

Question 7

What to check for in a candida infection

Answer 7

Oral thrush

Question 8

Satellite lesions

Answer 8

Small similar patches of rash or pustules near the main rash

Question 9

Management of nappy rash

Answer 9

Switching to highly absorbent nappies

Change the nappy and clean the skin as soon as possible after wetting or soiling

Use water or gentle alcohol free products for cleaning the nappy area

Ensure the nappy area is dry before replacing the nappy

Maximise time not wearing a nappy

Question 10

Management of nappy rash superinfection

Answer 10

Anti-fungal cream (clotrimazole or miconazole)

or antibiotic (fusidic acid cream or oral flucloxacillin)