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Nappy rash - Management
Basis for recommendation

These recommendations are based on expert opinion from review articles [Atherton, 2004; Gupta and Skinner, 2004; Scheinfeld, 2005].

Predisposing factors

  • There is limited evidence that frequent nappy changes, using disposable nappies, avoiding irritants, and frequent, gentle cleaning with water or fragrance-free and alcohol-free baby wipes reduce the incidence and severity of nappy rash (see Skin care advice).
  • A prospective study of 57 children showed that after 10 days of oral amoxicillin treatment, 16% of children developed nappy rash and there was a twofold increase in skin colonization with candida [Honig et al, 1988].

Clinical features of secondary infections

  • Expert opinion from review articles suggests that a candidal or bacterial infection can be clinically differentiated from non-infected nappy rash [Brook, 1992; Gupta and Skinner, 2004; Scheinfeld, 2005].
  • Case series show oral Candida to be associated with candidal nappy rash due to excretion of Candida in the faeces [Hoppe, 1997].

Skin swabs

  • Skin swabs are not generally recommended for the management of nappy rash as the results are difficult to interpret.
    • Both Candida and bacteria (such as Staphylococcus aureus) colonize healthy skin and a skin swab may be positive when infection is not present.
  • A swab should only be taken when a secondary bacterial infection is suspected, to guide choice of antibiotic [Leyden and Kligman, 1978; Ferrazzini et al, 2003].

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