OTC - nappy rash

Question 1

Symptoms?

Answer 1

• irritant nappy rash, erythematous (red) rash on buttocks
• fungal nappy rash - satellite rash (small red papules on the outer edge of rash)
• rash concentrated in skin folds (between the buttocks and the under cheeks)

Question 2

Referral criteria?

Answer 2

• broken skin, severe nappy rash
• yellow crust/weeping (secondary bacterial infection)
• other body areas affected - atopic eczema?
• OTC failure >1 week

Question 3

OTC product?

Answer 3

Barrier preparations - forms protective layer, rehydrates and soothes skin
- bepanthen, drapolene, sudocrem, metanium

Antifungal preparations

• clotrimazole BD and continue for 7 days till rash has gone (canesten antifungal)
• miconazole (daktarin) same as above

Question 4

Advice?

Answer 4

• skin care and nappy hygeine - change nappies as soon as they are soiled or wet (urine and faeces contain enzymes which are skin irritants)
• leave nappy off to allow skin to air dry (prolonged moisture macerates the skin)
• avoid waterproof nappies, worsens nappy rash
• wash nappy area thoroughly with water or wipes