An updated version is available in the linked supplement
Feature Article

Nappy rash

Gayle Fischer



Overhydration, heat and friction under the nappy are the most common causes of nappy rash. Once more serious conditions have been excluded, simple management techniques can be used to treat the rash and prevent recurrences.

Key Points

  • The most common causes of nappy rash are 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 the ulceration improves with the usual nappy rash treatment.
  • When nappy rash involves the flexures, the presence of an underlying dermatosis such as psoriasis should be considered.
  • 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 Group A 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 corticosteroids are a safe, appropriate treatment for this condition.