At a glance: Nappy dermatitis versus candida nappy rash

Nappy dermatitis may cause itching and pain

Nappy dermatitis

Discriminatory signs

  • Flexures are spared.
  • Patchy rash.
  • Erythema, if severe erosions and ulcers.
  • May itch and cause pain.
  • Urine and faeces will cause a rash on skin if left in contact for long.
  • Ammonia is formed and burns the skin.
  • May be associated with cradle cap or atopic dermatitis.

Management

  • Change the nappies frequently.
  • Neonates urinate more than 20 times daily; by the age of 1 year this has reduced to seven times daily.
  • Give evening fluids early to reduce wetting at night.
  • Wash the bottom at every change and pat dry. Apply moisturiser.
  • Leave the nappy off as much as possible.
  • Do not use powders such as talcum powder.

Candida nappy rash

Discriminatory signs

  • The rash includes creases.
  • Causes discomfort.
  • Beefy red papules.
  • Whitish scaling.
  • Pustules and satellite lesions seen around the margins of the main red area.
  • May be associated with oral lesions.
  • Enquire if the baby had recently had antibiotic therapy.

Management

  • Topical antifungal ointment such as nystatin can be followed in some cases by oral antifungals or be given simultaneously.
  • Topical imidazole cream should be considered in resistant cases.
  • Consider referral to a specialist if not responsive to therapy.

Contributed by Dr Vasa Gnanapragasam, GP in Sutton, Surrey.

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