Nappy rash is primarily an irritant contact dermatitis.
It is most common in the first 2 years of life, but can occur in a person of any age who routinely wears nappies.
Diagnosis is made by characteristic skin findings in the area of the body covered by a nappy; erythema of the convex surfaces of the buttocks is the classic finding.
Initial treatment involves reinforcing good nappy change practices, such as frequent nappy changes, use of super-absorbent disposable nappies, periods of nappy-free time, and application of barrier cream, ointment, or paste.
Recalcitrant nappy rash may signal secondary infection or underlying systemic or dermatological disorders, and requires further evaluation.
Nappy rash is inflammation of the skin in the area of the body covered by a nappy. It is primarily an irritant contact dermatitis. The main irritants are urine, faeces, and faecal enzymes, which lead to skin breakdown, typically of the perineum and convex surfaces of the buttocks, with sparing of the skin folds.
History and exam
Key diagnostic factors
- presence of risk factors
- acute onset of rash in nappy area
- erythema of convex surfaces in nappy area
- sparing of skin folds
Other diagnostic factors
- features of candidiasis
- features of Staphylococcus aureus infection
- features of group A Streptococcus infection
- young age (<2 years)
- underlying dermatological disorder
- oral antibiotics
- infrequent nappy changes
- excess use of baby care products
- excess detergent
- excess wiping
- plastic underpants
- no nappy-free time
- underlying skin infections
Investigations to consider
- potassium hydroxide test of skin scraping
- bacterial culture of skin
- fungal culture of skin
- serum zinc level
Linda S. Nield, MD, FAAP
Assistant Dean for Admission
Professor of Medical Education and Pediatrics
West Virginia University School of Medicine
LSN is an author of references cited in this topic.
Deepak Kamat, MD, PhD, FAAP
Professor of Pediatrics
Vice Chair for Academic Affairs
Department of Pediatrics
UT Health San Antonio
DK is an author of references cited in this topic.
Jonette E. Keri, MD, PhD
Assistant Professor of Dermatology and Cutaneous Surgery
University of Miami
Miller School of Medicine
JEK declares that she has no competing interests.
Martin E. Weisse, MD
Professor of Pediatric Infectious Disease
Walter Reed Army Medical Center
MEW declares that he has no competing interests.
Kam Lun Ellis Hon, MBBS, DCH, FAAP, FCCM
Department of Paediatrics
The Chinese University of Hong Kong
KLEH declares that he has no competing interests.
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