Nappy Rash is common in practice and examinations.
William brings his 3 month old son in to see you for non-resolving rash in his child as seen in the picture.
What is the most likely diagnosis?
What are the differentials of this condition?
What is the non-pharmacological treatment of this condition?
What is the pharmacological treatment of this condition?
Causes of nappy rash in infants
- Irritant dermatitis secondary to urine and faeces
- Candida
- Seborrhoeic dermatitis
- Psoriasis
- Miliaria
- Atopic dermatitis
- Staph infection
- Herpess Simplex
- Tinea
Pathology of nappy rash
Loss of skin barrier function from overhydration, friction, exposure to faecal enzymes, ammonia.
This can become colonised, particularly with candida
Protection against nappy rash
- Highly absorbent disposable nappies or change cloth nappies every 2 hours.
- Use soap substitute and dispersible bath oil for bathing
- Damp cloth and soap substitute for cleaning the nappy
- Barrier – like zinc
Non-pharmacological treatment of infant nappy rash
- At nappy changes – wipe clean with water and soft cloth
- Pat gently, allow to air dry
- Put barrier cream on
Pharmacological Treatment of infant nappy rash
Hydrocortisone 1% ointment topically BD until rash resolves
plus
nystatin 10000units /g cream topically BD
or
miconazole + zinc oxide ointment in thick layer topically
Treatment of severe nappy rash
stronger topical corticosteroid for 7 days
methylprednisolone aceponate 0,1% once daily
OR
tramcinolone acetonide 0-.02% topcially BD
plius
miconazole + zinc oxide ointment in thick layer topically
