What should you know about spotty nappy rash?

Irritant nappy rash commonly affects skin covered by the nappy and can look red, sore, shiny, or patchy. Warmth, dampness, stool, urine, rubbing, diarrhoea, antibiotics, and fragranced products can all weaken the skin barrier. Small spots around the edge of a bright red rash, or involvement of the skin folds, can occur with yeast irritation, but a clinician may need to confirm this.

Other rashes can mimic nappy rash, including contact reactions and some infections. The child’s age, comfort, feeding, temperature, and how quickly the rash appeared help determine urgency.

Change wet or soiled nappies promptly, rinse with lukewarm water or use fragrance-free wipes, and pat rather than rub. Give short periods without a nappy when practical, and apply a bland barrier or moisturiser to clean, dry skin; Emollient Therapy covers gentle barrier support. Avoid talc, fragranced products, harsh antiseptics, and scrubbing. Do not use an antifungal cream unless a pharmacist or clinician recommends the product and instructions.

Contact a clinician if the rash is spreading, very painful, blistered, bleeding, weeping, crusted, or not improving with gentle care. Seek prompt advice if the child has fever, seems unusually sleepy, feeds poorly, passes fewer wet nappies, or the rash involves the mouth or eyes. Topical Antifungal Treatment may be suitable when yeast is confirmed or strongly suspected.

Ask whether the pattern is irritant, yeast-related, or another rash; which barrier product is suitable; and how often it should be applied. Tell the clinician when it began, how often nappies are changed, whether there is diarrhoea or recent antibiotic use, and what products have touched the skin.