🔑 Key Learning

  • Nappy rash is a form of irritant contact dermatitis caused by prolonged contact with urine and faeces, leading to skin maceration and irritation
  • Characteristically spares skin folds, unlike candida which often involves them
  • Candida albicans and bacterial superinfection (e.g. Staph aureus) are common complications
  • Management involves barrier creams, mild topical steroids, and antifungal or antibiotics if required. 

🧬 Pathophysiology

  • Irritant contact dermatitis due to:
    • Prolonged exposure to urine/faeces
    • Skin maceration from overhydration
    • Friction from nappies
  • Secondary infection:
    • Candida albicans
    • Staphylococcus aureus or Streptococci

đź‘€ Clinical Features

  • Well-defined erythema, oedema, and dryness of:
    • Buttocks
    • Proximal thighs
    • Suprapubic region
  • Typically spares skin folds (e.g. inguinal and subgluteal creases)
  • Candida features:
    • Bright red patches
    • Papules or pustules
    • Satellite lesions
    • Scaling
Nappy rash
Figure 7: Nappy rash. Dailyboth, Irritant diaper dermatitis, CC0 1.0.

       

đź’Š Management

  • Conservative: High absorbency nappies, frequent nappy changes, regular skin cleaning
  • Mild rash, asymptomatic:
    • Barrier cream (e.g. zinc oxide) at each change
  • Inflamed or symptomatic:
    • Topical hydrocortisone 1% OD for 7 days
  • Suspected/confirmed candida:
    • Add topical imidazole cream (e.g. clotrimazole)
  • Bacterial infection:
    • Oral flucloxacillin

đź“ť Exam Clues & Clinchers

  • “Well-defined erythema sparing skin folds in infant” → classic irritant nappy rash
  • “Satellite pustules, red plaques, involves skin folds” → think Candida
  • Treatment: 1st line: Barrier cream + mild steroid +/- antifungal/abx