Nappy rash

Last reviewed: 1 Mar 2023
Last updated: 04 Feb 2021

Summary

Definition

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
More key diagnostic factors

Other diagnostic factors

  • features of candidiasis
  • features of Staphylococcus aureus infection
  • features of group A Streptococcus infection
  • fussiness
Other diagnostic factors

Risk factors

  • young age (<2 years)
  • diarrhoea
  • 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
More risk factors

Diagnostic investigations

Investigations to consider

  • potassium hydroxide test of skin scraping
  • bacterial culture of skin
  • fungal culture of skin
  • FBC
  • serum zinc level
More investigations to consider

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Linda S. Nield, MD, FAAP
Linda S. Nield

Assistant Dean for Admission

Professor of Medical Education and Pediatrics

West Virginia University School of Medicine

Morgantown

WV

Disclosures

LSN is an author of references cited in this topic.

Deepak Kamat, MD, PhD, FAAP
Deepak Kamat

Professor of Pediatrics

Vice Chair for Academic Affairs

Department of Pediatrics

UT Health San Antonio

San Antonio

TX

Disclosures

DK is an author of references cited in this topic.

Peer reviewers

Jonette E. Keri, MD, PhD

Assistant Professor of Dermatology and Cutaneous Surgery

University of Miami

Miller School of Medicine

Miami

FL

Disclosures

JEK declares that she has no competing interests.

Martin E. Weisse, MD

Professor of Pediatric Infectious Disease

Walter Reed Army Medical Center

Washington

DC

Disclosures

MEW declares that he has no competing interests.

Kam Lun Ellis Hon, MBBS, DCH, FAAP, FCCM

Associate Professor

Department of Paediatrics

The Chinese University of Hong Kong

Hong Kong

China

Disclosures

KLEH declares that he has no competing interests.

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