GuidelinesPrimary Care STG
Nappy Rash
Nappy Rash
L22
DESCRIPTION
- A diffuse reddish eruption in the nappy area, usually caused by irritation from:
- Persistent moisture and irregular cleaning and drying of the nappy area
- Diarrhoeal stools
- Underlying skin conditions in some cases, or
- Improper rinsing of nappies to remove urine and stool breakdown products
- Rash is predominantly on areas in contact with the nappy, and spares the flexures.
GENERAL MEASURES
- Prompt changing of soiled nappies
- Avoid waterproof pants
- Expose nappy area to air if possible especially with severe nappy dermatitis
- Educate caregiver on washing, rinsing and drying of the nappy when soiled
MEDICINE TREATMENT
- Zinc emollient, e.g.:
- Zinc and castor oil, topical, apply ointment after each nappy change
If rash involves the flexures, suspect candida:
- Imidazole, e.g.:
- Clotrimazole 1%, topical, apply cream beneath zinc and castor oil ointment after each nappy change until symptoms are resolved
REFERRAL
- No improvement after 3 days of treatment
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Review-Version-2.0-November-2025
Chapter 5: Skin Conditions_5.9 Nappy Rash