Napkin dermatitis

Napkin dermatitis is an acute inflammatory skin reaction in the area covered by the nappy.

What causes nappy rash?

Napkin dermatitis can be considered a form of irritant contact dermatitis.  Causes include prolonged contact with urine and faeces, as well as external irritants such as soaps, topical preparations, detergents and fabric softeners. This is exacerbated by overhydration and maceration of skin in the warm closed environment of a nappy. Candida albicans can also contribute to the mix.

What does it look like?

• An erythematous scaly rash which may include vesicles and papules. Skin erosions and fissures may also be present. 
• The area from the lower abdomen to the upper thigh may be involved, including the convex surfaces of the perineum, genitals and buttocks.
• Skin creases tend to be spared in irritant dermatitis, but not in candidiasis.

How do you manage napkin dermatitis?

• Change nappies frequently
• Expose the rash to air
• Use barrier creams with each nappy change (e.g. zinc and castor oil ointment).  Do not apply to broken skin (‘breathable’ barrier films such as Cavilon are a potential exception)
• Use soap substitutes
• Use mild corticosteroids if inflammation is causing discomfort (but try to avoid in neonates) – do not apply for more than a week
• Treat any associated candida or bacterial infection 

What’s the differential diagnosis?

• Flexural psoriasis
• Atopic dermatitis
• Acrodermatitis enteropathica 

References

E-Learning for healthcare dermatology

BNF for children

Medscape – Napkin Dermatitis