Peer Reviewed
Feature Article Paediatrics
Nappy rash
Abstract
Most babies will at some time suffer from some degree of nappy rash. The rash is usually not difficult to treat but has a tendency to recur as long as the patient continues to wear nappies. More severe forms are decreasing owing to the use of highly absorbent disposable nappies.
Key Points
- The commonest cause of nappy rash is overhydration, heat and friction under the nappy.
- Candida albicans usually colonises nappy rash, and antifungal creams improve outcome.
- Some rare but serious conditions can present as nappy rash unresponsive to treatment.
- Nappy rash can ulcerate. This is not a sinister sign, and recovers with the usual treatment.
- When nappy rash involves the flexures, consider an underlying dermatosis such as psoriasis.
- Seborrhoeic dermatitis is common in young babies, and looks much worse than it is.
- Any persistent perianal rash should be cultured for the presence of beta-haemolytic streptococci.
- A pustular rash under the nappy may be due to Staphylococcus aureus.
- Most parents are very concerned about the use of topical corticosteroids, and will need firm reassurance that they are a safe, appropriate treatment for this condition.
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