Nappy rash is a common sighting in primary care. It usually affects infants and toddlers. Although its symptoms are concerning for the caregivers and cause discomfort for the child, the condition itself is not serious. Nevertheless, the management of nappy rash is an essential skill for primary care doctors and basic training in general dermatology can be helpful.
Nappy rash (also called diaper rash) is an inflammatory skin condition. The symptoms, such as redness, swelling, and (sometimes) blistering or peeling of the skin, appear in the diaper area.
Main causes of nappy rash include:
The friction resulting from the rubbing of nappies against the skin and irritant contact dermatitis (prolonged contact with urine and faeces) are the main causes of nappy rash. Other causes may include allergies to certain nappy materials, wipes, or detergents. Last but not least, secondary bacterial (Staphylococcus aureus or Streptococcus), or Candida infections may worsen the rash.
A thorough history and physical examination are often sufficient to diagnose nappy rash. Key points include:
Primary care providers play a crucial role in managing nappy rash by addressing its causes, alleviating symptoms, and educating caregivers.
The general measures for nappy rash management include:
General practitioners should advise caregivers to change nappies as soon as they are wet or soiled to minimise exposure to irritants.
Recommend using lukewarm water and a soft cloth or fragrance-free, alcohol-free wipes to clean the area.
Encourage nappy-free time to allow the skin to breathe and heal.
Recommend the application of zinc oxide or petroleum jelly to protect the skin from irritants.
GPs should also discourage the use of talcum powder due to the risk of inhalation, emphasise the importance of nappy hygiene, and educate caregivers to avoid harsh soaps and perfumed products that can worsen irritation.
With mild cases of nappy rash, primary care doctors should recommend over-the-counter barrier ointments and make sure that caregivers are following the general measures consistently.
In moderate or severe cases, when fungal or bacterial infections and inflammation are present, antifungal topicals (Clotrimazole, Miconazole) and topical (Mupirocin) or oral antibiotics may be necessary.
The short-term use of a low-potency corticosteroid creams (hydrocortisone 1%) can help reduce severe inflammation.
It is best to refer a patient to a dermatologist or paediatric specialist if:
With a systematic approach, focus on prevention, and prompt treatment, nappy rash becomes an easily manageable condition in a primary care setting.
– Dr Rosmy De Barros
For further information on this topic, you may be interested to learn more about the HealthCert online Professional Diploma program in General Dermatology.
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