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Nappy rash - Management
How should I treat nappy rash?

  • For mild nappy rash that is not causing discomfort:
    • Advise about skin care.
    • Prescribe a barrier preparation to apply thinly at each nappy change, to protect the skin.
      • Zinc ointment BP, Zinc and Castor Oil ointment BP, or Metanium® ointment are recommended.
      • Alternatively, white soft paraffin BP ointment or dexpanthenol 5% ointment (Bepanthen®) could be used.
  • For nappy rash that is causing discomfort:
    • Advise about skin care.
    • Prescribe a barrier preparation to apply at each nappy change.
    • Consider prescribing a topical hydrocortisone 0.5–1% cream once a day until symptoms settle for up to a maximum of 14 days.
      • Advise parents to apply topical hydrocortisone first and wait a few minutes before applying the barrier preparation.
  • If a candidal infection is confirmed or suspected:
    • Advise about skin care.
    • Advise parents not to use a barrier preparation until after the candidal infection has settled.
    • Prescribe a topical imidazole cream (clotrimazole, econazole, ketoconazole, or miconazole) 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.
    • If inflammation is causing discomfort, consider prescribing topical hydrocortisone in addition to a topical imidazole, or using a combined antifungal and hydrocortisone cream.
      • 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.
  • If bacterial infection is confirmed or suspected:
    • Advise about skin care.
    • Prescribe a barrier preparation to apply at each nappy change.
    • Prescribe oral flucloxacillin for 7 days (oral erythromycin or clarithromycin for 7 days are alternatives for children who are allergic to penicillin — see prescriptions).
      • Adjust treatment if indicated by swab results.
    • If inflammation is causing discomfort, consider prescribing hydrocortisone 0.5–1% cream once a day until symptoms settle, for a maximum of 14 days.
  • Do not use talcum powder, vitamin A, topical antibiotics, or oral antifungals to treat nappy rash.
  • If symptoms are not settling, see Management if treatment fails.

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