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Nappy rash - Management
How should I assess a child with nappy rash?
- Ask about factors which predispose a child to nappy rash:
- Hygiene practices (for example how often the area is cleaned and the nappy changed) — lack of hygiene predisposes to irritant dermatitis.
- Type of nappy used — disposable nappies or reusable cotton nappies.
- Exposure to irritants — such as soaps, detergents, or alcohol-based baby wipes.
- Trauma — for example, friction from nappies or over-vigorous cleaning.
- Recent antibiotic use — antibiotics predispose to candida colonization.
- Look for clinical features which suggest secondary infection:
- Bacterial infection — marked redness with exudate, and vesicular and pustular lesions.
- Candidal infection — sharply marginated redness around the perianal skin, which may involve the perineum. Confluent zones of papules and pustules involving the skin creases. Satellite lesions are characteristic of candida infection.
- Check for oral candidiasis — if present, it increases the likelihood of nappy rash with candidal colonization (see the CKS topic on Candida - oral).
- Take a skin swab if a secondary bacterial infection is suspected, particularly when the nappy rash:
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