Nappy Rash, Tinea Flashcards
What is a Nappy Rash?
- Inflammation of the skin in the area of the body covered by a nappy
- It is Common
What are the common causes of Nappy Rash?
Contact dermatitis
Infantile Seborrheic dermatitis
Candida
Atopic Eczema
What are the rare Nappy Rash causes?
▪ Acrodermatitis enteropathica
▪ Langerhans cell histiocytosis
▪ Wiskott-Aldrich syndrome
What is the aetiology of Contact dermatitis Nappy Rash?
Most common
• May occur if nappies are not changed frequently or if infant has
diarrhoea, but can also occur even if infant is cleaned regularly
• Occurs due to the irritant effect of urine ammonia and faeces on the
skin
• Urea-splitting organisms in faeces increase alkalinity and likelihood
of a rash
What is the aetiology of Candida Nappy Rash?
- Infections can cause or exacerbate nappy rashes
* Other pathogens: Staphylococcus aureus, enteric organs
What are the clinical features of contact dermatitis in a Nappy Rash?
o Characteristic acute onset erythematous rash of convex surfaces of buttocks, perineal
region, lower abdomen and tops of thighs
o Flexures (creases) are characteristically spared in irritant dermatitis
o More severe forms may involve erosions and ulcer formation
What are the clinical features of Candida and Seborrheic dermatitis?
• Candida infection
o Erythematous rash including skin flexures
o May have satellite lesions
• Seborrheic dermatitis
o Erythematous rash with flakes
o May have coexistent scalp rash
What are the clinical features of Psoriasis and Atopic eczema in a Nappy Rash?
• Psoriasis
o Less common cause characterised by erythematous scaly rash also present elsewhere
on skin
• Atopic eczema
o Other areas will also be affected
How do you diagnose a nappy rash?
Clinical examination
What advice do you give parents/ carers about self management strategies?
o Consider using a nappy with high absorbency and ensure that it fits properly
o Disposable nappies preferable to towel nappies
o Leave nappy off as much as possible to help skin drying of the nappy area
o Clean the skin and change the nappy every 3-4 hours or as soon as possible after
wetting/soiling, to reduce skin exposure to urine and faeces
▪ Use water, or fragrance-free or alcohol-free baby wipes
▪ Dry gently after cleaning
▪ Bath the child daily
▪ Do NOT use soap, bubble bath, lotions or talcum powder
If the child has mild erythema and is asymptomatic what do you do?
o Advise on the use of barrier preparation to protect the skin (available OTC)
▪ These physically block chemical irritants and moisture from contacting the
skin and minimise friction
▪ Usually contain petrolatum or zinc oxide
o Apply thinly at each nappy change
If the rash is inflamed what should you prescribe?
If > 1 month = hydrocortisone 1% cream OD (max 7 days)
If Candida is suspected how do you treat the Nappy Rash?
o Advise against the use of barrier protection
o Prescribe topical imidazole cream (e.g. clotrimazole, econazole, miconazole, nystatin)
o Frequency depends on preparation used
If a bacterial Nappy Rash is suspected what should you do to manage it?
o If mild and localised: topical mupirocin
o If severe: oral flucloxacillin for 7 days
o If penicillin allergy: clarithromycin (7 days)
What are the different types of Tinea?
o Tinea pedis: athlete’s foot o Tinea ungulum: finger and toenails o Tinea corporis: arms, legs and trunks o Tinea cruris: groin area o Tinea manuum: hands and palm o Tinea capitis: scalp - sometimes acquired from dogs and cats and causes scaling and patchy alopecia with broken hairs o Tinea faeciei: face o Tinea barbae: facial hair
What is tinea (dermatophytosis)?
• Superficial fungal infection in which dermatophyte fungi invade dead keratinous structures,
such as the horny layer of skin, nails and hair
• Can be caused by various different types of fungi (dermatophytes)
What investigations do you do for Tinea?
Examination under filtered ultraviolet (Wood’s) light may show bright greenish/yellow
fluorescence of the infected hairs with some fungal species
• Rapid diagnosis can be made from microscopic examination of skin scrapings for fungal
hyphae
• Definitive identification of the fungus is by culture
What is the management of Tinea?
• Mild infections are treated with topical antifungals
• More severe infections will require systemic antifungals
• Tinea Capitis
o Systemic antifungal therapy (e.g. griseofulvin or terbinafine)
o 2nd line: itraconazole or fluconazole
o Topical antifungal shampoo is recommended in some patients (e.g. selenium sulfide
or ketoconazole topical)
• Tinea Faciale, Tinea Corporis, Tinea Cruris or Tinea Pedis
o Topical antifungal (e.g. terbinafine, naftifine, butenafine)
o Topical aluminium acetate (in some)
• NOTE: any animal source of the infection will also need treatment
