- 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.
- 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
- 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.
- 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.