23
SA Pharmacist’s Assistant [Summer 2017]
MOTHER AND CHILD
Introduction
Nappy rash is a common condition that appears as a patchwork of bright red, inflamed skin on the baby's bottom.1-3 Nappy rash occurs most commonly in infants between ages nine and twelve months, but may occur at any time the child wears a nappy. Fortunately, most cases of nappy rash are short-lived and resolve with home treatment.1
Causes
The main cause of nappy rash is wearing a wet or dirty nappy for too long. Prolonged dampness, friction and ammonia substances released from urine may irritate the child’s skin.
Plastic pants often make nappy rash worse because they stop air circulating normally and keep the nappy area damp. Soaps and detergents left on cloth nappies after washing may also contribute to nappy rash.4
Signs and symptoms
Nappy rash is characterised by the following3,5:
Skin signs
The skin in the nappy area generally looks red and raw and may be spotty in appearance, particularly at the edges of the rash.
The skin may feel hot to the touch, and there may be spots, pimples or blisters present.5 The rash can spread upwards towards the child’s tummy or back.4 The skin may be sore or itchy when the area is wiped.5
Changes in the baby's disposition
The rash may cause discomfort and pain, which can make the baby irritable. 4
Management of nappy rash
If the skin is unbroken and there are no signs of a secondary bacterial or fungal infection, over-the-counter (OTC) treatment may be considered.2 Mild nappy rash usually clears up with simple at-home treatments, such as air drying, more frequent nappy changes and by applying protective barrier ointments.3 A baby with nappy rash that does not respond to skin care and OTC treatment within one week should be seen by a doctor.2
Complications of nappy rash
The area covered by the nappy is especially vulnerable to secondary infections, because it is warm and moist, making a perfect breeding ground for bacteria and yeast/fungi.3 Bacterial skin infections, such as impetigo, may be associated with pustules or tiny blisters.6 Fungal infections such as thrush (Candida) appear as bright red, shiny areas in the nappy area.
These red areas have clearly defined borders. These rashes may be found within the creases of the skin, and there may be red dots scattered around the creases.3,4
Topical antibiotics and antifungals are available for treatment in these situations. However, it is recommended that the nappy region be examined by a doctor to make a correct diagnosis.6
Soothing a nappy rash
Haley Van Wyk, BPharm Amayeza Information Services
Nappy Rash
Source: https://www.webmd.boots.com/children/baby/guide/nappy- rash-irritation
24 SA Pharmacist’s Assistant [Summer 2017]
MOTHER AND CHILD
Conclusion
Most babies will have nappy rash at some stage during their infancy. Advice from the pharmacist’s assistant is important
in both treating and preventing recurrence of the problem.
However, if the rash is severe, worsening or is associated with other signs or symptoms, the child's healthcare provider should be contacted immediately.
References
1. Horii KA, MD. Patient education: Diaper rash in infants and children (Beyond the Basics). UpToDate. Last updated: Jul 24, 2017. c2017. Available from: https://www.uptodate.com/contents/diaper-rash-in-infants-and- children-beyond-the-basics
2. Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the Pharmacy. A Guide to the Management of Common Illness. 5th Edition. Napkin Rash.
Pages 286-303.
3. Mayo Clinic. Diaper rash. c2017. Accessed: 9/10/17. Available from: http://
www.mayoclinic.org/diseases-conditions/diaper-rash/basics/definition/
con-20019220
4. By raising children network. Nappy rash. Last updated or reviewed 7/10/15.
c2017. Available from: http://raisingchildren.net.au/articles/nappy_rash.
html
5. The Royal Children’s Hospital Melbourne. Nappy rash. Updated November 2010. Available from: https://www.rch.org.au/kidsinfo/fact_sheets/Nappy_
rash/
6. Mersch J. Diaper rash. Medicinenet. Reviewed on 8/22/2016. c2017. Available from: http://www.medicinenet.com/diaper_rash/article.htm
Table I. Management of nappy rash
Treatment of nappy rash includes a combination of the following measures, which are most effective when used together.1,4-6 Change the baby’s nappies frequently
Frequent nappy changes keep the nappy area dry and give the child’s skin a chance to heal. Nappies should be changed often (about five to seven times a day in babies under 12 months old), which reduces the amount of time that urine and faeces are in contact with the skin.
Air the skin
The most effective way to treat irritant nappy rash is to reduce skin contact with urine and faeces (i.e. by discontinuing or limiting the use of nappies). One way to do this is to allow the child to periodically go without a nappy, allowing the skin to be exposed directly to the air.
Keep the skin clean
At each nappy change the baby's bottom should be gently wiped with cotton wool or a soft cloth, dampened with lukewarm water. If using disposable wipes, make sure that they are alcohol or fragrance-free, to prevent stinging and irritation to the raw areas on the baby’s skin. Some babies might be allergic to substances in disposable wipes.
Bath the baby daily. Gentle cleansing with warm water and a soft cloth is usually sufficient. Do not use soap, bubble bath or lotions. If soap is desired, a mild, fragrance-free product is recommended.
Use disposable nappies
Use disposable nappies during an episode of nappy rash, as they are highly absorbent and specifically designed to minimise skin exposure to wetness. While cloth nappies are good for the environment, they do not take up moisture as well as disposable nappies.
Rinse cloth nappies thoroughly after they’re washed
This gets rid of soap residue in the baby’s nappy. Bleach is most effective for killing bacteria, but make sure to rinse the nappies well in fresh water after using bleach-based detergents. Ensure the nappies are dry before using them again.
Application of topical barriers to the nappy region
Skin ointments or pastes may help to treat or prevent irritant nappy rash. These include zinc oxide, lanolin or white soft paraffin. The ointment or paste should be applied at every nappy change. In addition, products that contain preservatives, fragrances, or other additives are not recommended because they may further irritate the skin.
Topical corticosteroids
In general, topical corticosteroids are not recommended because they may be irritating. If the child's skin becomes severely inflamed, the doctor may prescribe a topical corticosteroid. This may be applied in a thin layer to the irritated skin twice daily for no more than one week.
Nappy rash with Candida
Source: https://patient.info/health/nappy-rash-leaflet
