Nappy rash

Question 1

Irritant dermatitis

Answer 1

Most common cause
Due to irritant effect of urinary ammonia and faeces
Creases are characteristically spread

Question 2

Candida dermatitis

Answer 2

Erythematous rash
Involve the flexures
Characteristic satellite lesions

Question 3

Seborrhoeic dermatitis

Answer 3

Erythematous rash with flakes

May be coexistent scalp rash

Question 4

Psoriasis

Answer 4

Less common cause characterised by an erythematous scaly rash
Also present elsewhere on the skin

Question 5

Atopic eczema

Answer 5

Other areas of the skin will also be affected

Question 6

General management

Answer 6

Disposable nappies preferable to towel nappies
Expose napkin area to air when possible
Apply barrier cream (e.g. Zinc and castor oil)
Mild steroid cream (e.g. 1% hydrocortisone ) in severe cases
Management of suspected candidal nappy rash with topical imidazole. Cease the use of a barrier cream until the candida has settled