Neonatal - nappy rash

Question 1

What is nappy rash?

Answer 1

acute inflammatory reaction of skin in nappy area

irritant contact dermatitis

Question 2

Pathophysiology

Answer 2

skin barrier function compromised by skin maceration, friction, prolonged skin contact urine/faeces
increased skin pH

Question 3

complications

Answer 3

secondary candida and bacterial (staph aureus/strep) infection

Question 4

% affected

Answer 4

25%

Question 5

risk factors

Answer 5

skin cleaning regime
type of nappy
baby wipes
recent diarrhoea and antibiotic use

Question 6

Child presentation

Answer 6

child distressed/agitated/uncomfortable

rash itchy/painful

Question 7

appearance of rash

Answer 7

confluent erythema

scattered papules over buttocks, genitalia, suprapubic area and upper thighs

Question 8

what areas are spared?

Answer 8

inguinal skin creases

gluteal cleft

Question 9

what may be present if severe involvement?

Answer 9

skin erosions
oedema
ulceration

Question 10

Assessing the child

Answer 10

ask about rash and any previous episodes
barrier preparations?
oral candidiasis
skin swab if infection

Question 11

management

Answer 11

parent education - nappy high absorbency, changing, alcohol free wipes, drying, avoid irritants
barrier preparation
1% hydrocortisone
oral antibiotics - infection

Question 12

4 types

Answer 12

ammonia dermatitis
candida/thrush
seborrhoeic dermatitis
isolate, psoriasis like plaques

Question 13

example of barrier cream

Answer 13

sudocrem - zinc oxide

Question 14

hallmark of candidia/thrush

Answer 14

satellite spots beyond the main rash

Question 15

treating candida/thrush

Answer 15

barrier cream
clotrimazole
+/- 1% hydrocortisone

Question 16

2 treatments to avoid treating candida

Answer 16

antifungals - hepatotoxic

gentian violet