Eczema: napkin eczema

Patient Information Leaflet
Link: Napkin dermatitis (nappy rash, napkin eczema)

https://www.pcds.org.uk/patient-info-leaflets/napkin-dermatitis-nappy-rash-napkin-eczema

Napkin eczema is usually caused by the contact irritant effects of the nappy contents, in which case skin folds tend to have relative sparing (unless associated with a secondary infection such as candida).

This chapter is set out as follows:

• A contact irritant effect of the nappy contents is the main cause - flexures tend to be spared 

• A similar picture can be seen as part of atopic eczema

• Secondary infection with bacteria and candida is not uncommon, the latter causes satellite lesions with no sparing of the folds

• The prolonged wearing of wet or soiled nappies may indicate ammoniacal dermatitis, which causes erosions and ulceration - this is less common now that disposable nappies are widely used

General management advise

• Consider using a nappy with high absorbency (for example, disposable gel matrix nappies compared with non-disposable nappies)
• Leave nappies off for as long as possible to help skin drying of the nappy area
• Clean the skin and change the nappy every 3–4 hours, or as soon as possible after wetting or soiling, to reduce skin exposure to urine and faeces
• Ensure the nappy fits properly (too tight increases skin occlusion; too loose minimises absorption of fluids)
• Parental/carer choice will depend on issues such as convenience, cost, and environmental impact
• Use water, or fragrance-free and alcohol-free baby wipes
• Dry gently after cleaning - avoid vigorous rubbing
• Bath the child daily - avoid excessive bathing (such as more than twice a day) which may dry the skin excessively
• Do not use soap, bubble bath, lotions, talcum powder, or topical antibiotics which can have an irritant effect

Management of mild erythema in an asymptomatic child

• Advise on the use of a barrier preparation to protect the skin, such as Metanium ® Nappy Rash Ointment or Conotrane ® cream
• Advise to apply thinly at each nappy change

Management of significant erythema and/or apparent discomfort

• In addition to the above, treat with an antifungal / hydrocortisone combination such as Daktacort ® cream BD. Stronger topical steroids such as Trimovate ® cream are occasionally needed for a few days
  
• If there is limited response take a swab and treat infection accordingly 
• Consider referral for moderate-severe cases not responding to treatment