Nappy rash is contact dermatitis in the nappy area. It is usually caused by friction between the skin and nappy and contact with urine and faeces in a dirty nappy. Most babies will get nappy rash at some point, and it is most common between 9 and 12 months of age. Additionally, the breakdown in skin and the warm moist environment in the nappy can lead to added infection with candida (fungus) or bacteria, usually staphylococcus or streptococcus.
Risk Factors
- Delayed changing of nappies
- Irritant soap products and vigorous cleaning
- Certain types of nappies (poorly absorbent ones)
- Diarrhoea
- Oral antibiotics predispose to candida infection
- Pre-term infants
Presentation
Nappy rash present with sore, red, inflamed skin in the nappy area. The rash appears in individual patches on exposure areas of the skin that come in contact with the nappy. It tends to spare the skin creases, meaning the creases in the groin are healthy. There may be a few red papules beside the affected areas of skin. Nappy rash is uncomfortable, may be itchy and the infant may be distressed. Severe and longstanding nappy rash can lead to erosions and ulceration.
Nappy Rash versus Candidal Infection
Candida in the nappy area (thrush) is a common finding. Signs that would point to a candidal infection rather than simple nappy rash are:
- Rash extending into the skin folds
- Larger red macules
- Well demarcated scaly border
- Circular pattern to the rash spreading outwards, similar to ringworm
- Satellite lesions, which are small similar patches of rash or pustules near the main rash
Check for oral thrush with a white coating on the tongue, as this is likely to indicate a fungal infection in the nappy area.
Management
Simple measures can be taken to improve skin health and treat nappy rash within a few days:
- Switching to highly absorbent nappies (disposable gel matrix nappies)
- Change the nappy and clean the skin as soon as possible after wetting or soiling
- Use water or gentle alcohol free products for cleaning the nappy area
- Ensure the nappy area is dry before replacing the nappy
- Maximise time not wearing a nappy
Infection with candida or bacteria warrants treatment with an anti-fungal cream (clotrimazole or miconazole) or antibiotic (fusidic acid cream or oral flucloxacillin).
Complications
- Candida infection
- Cellulitis
- Jacquet’s erosive diaper dermatitis
- Perianal pseudoverrucous papules and nodules
Last updated January 2020