Abstract

A 6-month-old boy came to the hospital, who has had a sore bottom for the past week. His parents say that he is crying a lot when he has his nappy changed. He has not had any skin problems prior to this. He has recently experienced gastroenteritis and has passed a lot of loose stools. 

Diagnosis

The diagnosis is nappy rash or napkin dermatitis - a common dermatological condition in infants, predominantly affecting those aged 3–15 months.

Napkin dermatitis follows damage to the normal skin barrier and is a form of irritant contact dermatitis. Primary factors that can cause napkin dermatitis include skin maceration (caused by prolonged contact with urine or faeces/diarrhoea), friction, and poor skin care.

Management

The NICE Clinical Knowledge Summary on Nappy rash provides a clear approach to management.Self-management strategies include using higher absorbency nappies, leaving nappies off for as long as possible (to help the skin dry), and cleaning the skin every 3–4 hours or as soon as wetting/soiling occurs.

If there is mild erythema and the child has no other symptoms then an over-the-counter barrier preparation such as lotion consists of Mineral Oil (Light Liquid Paraffin) can be used. Parents were advised to apply it thinly at each nappy change as a thick layer can cause water retention and worsen the symptoms.

If the affected skin is inflamed and causing discomfort, then a mild topical steroid or a dry skin moisturiser can be used underneath the barrier cream.

Conclusion

Nappy rashes are common, chronic, and often difficult to manage condition that is frequently encountered in the primary care setting. The parents were initially advised to use some specific ointment cream instead of the usual antiseptic cream. This led to a slight improvement, which quickly settled the rash. The infant has not had any symptoms since.

Suggested reading

1. vanOnselen J. Napkin dermatitis in infants: overview and current treatment guidance. BJFM, 2018. bjfm.co.uk/napkin-dermatitis-in-infants-overview-and-current-treatment-guidance (accessed 12 November 2018).
2. Dermnet New Zealand. Napkin dermatitis. Dermnet NZ, 2017. dermnetnz.org/topics/napkin-dermatitis (accessed 12 November 2018).
3. NICE. Nappy rash. NICE Clinical Knowledge Summary. NICE, 2018. cks.nice.org.uk/nappy-rash (accessed 12 November 2018)