Nappy rash (or napkin rash) is a term used to describe an erythematous macular, papular rash located around the nappy area that can spread to the lower abdomen or upper thighs. It typically presents in infants aged 3-15 months or in children or adults that are incontinent and wear pads.
Nappy rash is a form of contact dermatitis where the skin barrier is damaged due to a variety of causes. Typically, the skin is irritated from the high pH of faeces or urine, causing the skin to become over hydrated. It is reported that breastfed babies are less likely to get nappy rash as the pH in their stool is lower when compared to bottle fed babies. However, the pH then rises when solids are introduced into their diet.
Nappy rash can also be caused by a variety of other skin conditions such as candida, impetigo, psoriasis or atopic eczema.
Normally nappy rash does not require medication. Nappy free time is encouraged to let the skin breath and regular application of barrier creams is essential, particularly post bowel movement. If this rash persists or the clinical presentation changes, skin swabs may need to be taken to exclude fungal/bacterial causes. If this is suspected, creams can be prescribed accordingly.