GPAtlas🧭 When to suspect
Nappy rash is the common term for napkin dermatitis – most often an irritant contact dermatitis driven by prolonged skin contact with urine and faeces, friction, and occlusion under the nappy.
• Nappy rash affects over half of infants and peaks between 9 and 12 months.
• It is usually mild and self-limiting.
• Recognise the pattern and identify a secondary candidal or bacterial infection.
• Know when a non-resolving rash should make you question the diagnosis.
| Pattern | Typical features |
|---|---|
| Irritant contact dermatitis (most common) | • Glazed erythema on the convex surfaces (buttocks, genitals, lower abdomen, inner thighs) • The skin folds are typically spared |
| Secondary candidal infection | • Beefy-red erythema involving the flexures with satellite papules/pustules • Often follows diarrhoea or broad-spectrum antibiotics |
| Secondary bacterial infection | Weeping, golden/yellow crusting, or pustules (Staphylococcus/Streptococcus). |
| Alternative dermatosis | Consider napkin psoriasis or seborrhoeic dermatitis if well-demarcated, greasy-scaled, or not responding (see Clinical Pearl). |
|
🧠 Clinical pearl – look beyond candida when it won't settle • A nappy rash that fails to clear with correct skin care is a prompt to rethink the diagnosis, not simply to escalate the steroid. • Consider napkin psoriasis: well-demarcated, often shiny plaques that may involve the folds, with psoriasis elsewhere or a family history. • Consider seborrhoeic dermatitis: salmon-pink, greasy scale, with scalp/face involvement in an otherwise well baby. • Rarely, a treatment-resistant erosive rash signals a serious cause: • Langerhans cell histiocytosis – petechiae, purpura, brownish scale, systemic features. • Acrodermatitis enteropathica from zinc deficiency – sharply demarcated peri-oral, perianal and acral rash with diarrhoea and faltering growth. |
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