Nappy rash and thrush

Question 1

What are the types of nappy rash?

Answer 1

1. Irritant dermatitis:
   => most common cause, desquamating rash
   => creases/folds characteristically spared unlike seborrhoeic dermatitis
   => due to moisture retention, not due irritant effect of urinary ammonia
2. Candida dermatitis:
   => typically erythematous
   => flexures affected
   => characteristic satellite lesions beyond main rash
3. Seborrheic dermatitis:
   => erythematous diffuse, shiny rash with flakes extends into skin folds
   => co-existent scalp rash (occiput/cradle cap)
4. Psoriasis:
   => less common cause
   => characterised by erythematous scaly rash present everywhere on skin
5. Atopic eczema:
   => other areas of skin also affected

Question 2

How do you manage nappy rash?

Answer 2

1. Disposable nappies > towel nappies
2. Expose napkin skin area to air when possible
3. Apply barrier cream e.g. zinc and caster oil (sudocrem)
4. Mild steroid cream e.g. 1% hydrocortisone in severe cases
5. Suspected candida nappy rash treat with topical imidazole or clotrimazole ± 1% hydrocortisone cream
   => cease use of barrier cream until candida settled