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Nappy rash - Management
What should I do if treatment for nappy rash fails?

  • Review the diagnosis, and check compliance with skin care advice and treatment (if prescribed).
  • For nappy rash that persists despite hygiene advice and a barrier preparation:
    • Prescribe topical hydrocortisone in addition to a topical imidazole, or use a combined imidazole and hydrocortisone cream. For further information, see Prescriptions.
      • If using separate creams, advise parents to apply one cream first and wait a few minutes before applying the second cream.
      • Topical hydrocortisone should be stopped once symptoms settle, or after a maximum of 14 days.
  • For nappy rash that persists despite topical hydrocortisone:
    • Consider candidal infection.
    • Stop the topical hydrocortisone.
    • Advise parents not to use a barrier preparation until after the candidal infection has settled.
    • Prescribe a topical imidazole cream (clotrimazole, econazole, ketoconazole, miconazole, or sulconazole) two or three times a day.
      • Apply only a thin layer of cream to prevent moisture entrapment.
      • The frequency of application and duration of treatment depends on the imidazole used. For more information, see Prescriptions.
  • For nappy rash that persists despite topical hydrocortisone and topical imidazole treatment:
    • Take a skin swab (if this has not been done already) to exclude a bacterial infection.
    • Stop the topical hydrocortisone.
    • Prescribe a different topical imidazole cream (clotrimazole, econazole, ketoconazole, miconazole, or sulconazole) to be used twice or three times a day.
      • Apply only a thin layer of cream to prevent moisture entrapment.
      • The frequency of application and duration of treatment depends on the imidazole used. For more information, see Prescriptions.
  • For a presumed nappy rash with secondary bacterial infection that persists despite an oral antibiotic:
    • Consider an alternative diagnosis.
    • Review the swab result to exclude a yeast infection, and check antibiotic sensitivities:
      • Adjust treatment if indicated by swab results, or
      • Seek specialist advice if the nappy rash has not responded to an appropriate antibiotic.

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