A worried couple brought in their 3-week old son to the GP. He had previously come in 7 days ago, with a nappy Rash (which was diagnosed as possible Impetigo) and was prescribed a hydrocortisone (steroid) cream and miconazole (antifungal). The rash had started 3 days prior to the previous appointment. The parents described the rash as being fist size and surrounding his anus. There was no obvious cause of onset. The rash caused pain to the baby and the previously prescribed medications were having no effect. The baby was otherwise generally well, was feeding normally and was opening his bowels regularly. Everything seemed fine, except for this rash.

Upon examination, the child did indeed have a rash around his anus, though this was not nearly big enough to warrant a description of ‘fist’ size. The mother’s fists were also quite large – larger than mine. A beastly mother (if I can say that). So, definitely not HER fist size. Instead, the rash was the size of a £2 coin. It was red, not hot to touch and not scaly. There was no raise in the level of the skin.

The word I would use to describe what I saw would be ‘sore’.

The GP agreed with me. The soreness could be attributed to the baby’s passage of stool.

 The parents were told to continue using the hydrocortisone and miconazole creams, and to also use Sudocrem, because the zinc oxide in it could help act as a barrier from further exacerbation. Sudocrem contains a water-repellent base (consisting of oils/waxes); protective and emollient agents; antibacterial and antifungal agents; and a weak anaesthetic. As well as Nappy Rash, it can also treat eczema, bedsores, acne, minor burns, surface wounds, sunburn and chilblains (Shout out to Wikipedia).

 In addition to this, the couple were told to leave the nappies off for as long as possible each day, to avoid further irritation of the skin. The longer the skin is occluded, the greater the risk of persistent dermatitis due to ongoing increases in skin hydration, pH, and frictional damage.

A point to note is that skin swabs are not generally recommended for the investigation of nappy rashes. Both candida and bacteria colonise healthy skin and so false positives may occur. The swab should only be taken if a secondary bacterial infection is suspected, to help guide the choice of antibiotic.

P.S do not use talcum powder, vitamin A, topical antibiotics, or oral antifungals to treat nappy rash.

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Written by Jamil Shah Foridi

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