Nappy Rash Flashcards
What is nappy rash?
Irritant contact dermatitis which presents as inflammation of the skin in areas covered by the nappy.
What are the main irritants which cause nappy rash?
Urine
Faeces
Faecal enzymes
What are the main symptoms of nappy rash?
Red patches
Sore skin
Hot to touch
Potentially spots and blisters over rash
Baby distressed/irritable
What are some risk factors for nappy rash?
Young age <2
History of diarrhoea
Underlying dermatological disorder
Infrequent nappy changes
Excess use of baby care products
Plastic underwear
Limited nappy-free time
Worsens during teething (increased saliva changes nature of faeces).
What are some complications of untreated nappy rash?
Bacterial and fungal infection
Further distress for baby
What are some symptoms of Candida infected nappy rash?
Shiny red, raised patches with satellite lesions (red spots/small pustules along edge of rash) in the nappy area, folds of groin, neck, and armpit.
Oral candidiasis
What are some symptoms of S. aureus infected nappy rash?
Pustules
Vesicles
Bullae/large clear blisters
Denuded skin
Honey-coloured crusting
Fever >38C
Bleeding
Crying
Lethargy
What are some lifestyle advice for nappy rash?
Clean the whole nappy area gently but thoroughly, wiping from front to back.
Use water or fragrance-free and alcohol-free baby wipes.
Bath baby daily (avoid >2x) and dry baby gently after.
Avoid using soap, bubble bath, lotions or talcum powder.
Air skin out/nappy free time by lying baby out on towel.
Change frequently and ASAP after dirtying
Apply a thin layer of barrier cream after nappy change.
How can nappy rash be treated OTC?
- Lifestyle advice
If > 3 days - topical barrier cream
- topical antifungal therapy
When does nappy rash require a GP referral?
If symptoms are severe, suggest infection, or if pain is suspected
What can the GP prescribe for nappy rash?
In addition to OTC advice/products:
Not infected: Low-potency topical corticosteroids such as 1% hydrocortisone
Infected: A topical antibacterial therapy such as mupirocin.
They may then refer to a dermatologist.
How should topical corticosteroids be applied for nappy rash?
The smallest quantity needed should be applied thinly, twice daily, for 3 days and for no longer than 2 weeks.
What are barrier creams?
Form a barrier between the skin and irritants such as urine and faeces.
How should you advise parents to use barrier creams?
After cleaning up soiled nappy and skin, wash hands.
Apply cream to finger tip and apply a thin layer of barrier cream or ointment just before putting on each nappy. A small amount should be applied as large amounts of the barrier cream may reduce the ‘breathability’ of the nappy.
If there seems to be evidence of infection, barrier cream can make worse. If you notice rash worsening or further irritation, come back.
Many contain paraffin which is highly flammable so keep baby and product away from naked flames.
What are some examples of barrier creams?
Zinc and castor oil ointment
Metanium
White soft paraffin ointment
Bepanthem ointment
Conotrane - contains barrier (dimeticone) and antiseptic
Sudocrem - contains zinc oxide which acts as a barrier, astringent (shrink tissue for soothing effect) , and mild antiseptic
