Feature Article

Nappy rash

Gayle Fischer



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.