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. It affects over half of infants, peaks between 9 and 12 months, and is usually mild and self-limiting. The key primary-care skills are to recognise the pattern, identify a secondary candidal or bacterial infection, and 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) and 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) or acrodermatitis enteropathica from zinc deficiency (sharply demarcated peri-oral, perianal and acral rash with diarrhoea and faltering growth). |
Source: NICE · DermNet
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