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2017 HCHB_digital

Nappy Rash Nappy rash is

Nappy Rash Nappy rash is a red rash that occurs on the skin covered by a baby’s nappy. Any part of the groin area, particularly around the genitals and buttocks may be affected. Symptoms vary, depending on how severe the rash is. With mild nappy rash, only a small part of the nappy area is covered in either small pink spots or blotches. Babies may experience a stinging sensation and cry when passing urine or a bowel motion. In more severe nappy rash, the rash may spread down the legs or up onto the tummy. The skin may crack or break and blisters may appear. The baby may seem more irritable than usual and cry more often. Nappy rash is a very common problem – most babies will have it at some time – and it is important to reassure caregivers it does not mean the baby is not being looked after properly. antibiotics, and residual detergents left in cotton nappies after washing may also aggravate it. Nappy rash due to a yeast infection The warm, damp skin under a baby’s nappy provides a good place for microorganisms to grow. Candida albicans is a yeast (a type of fungus) that is Causes Simple nappy rash Simple nappy rash is most often due to irritation from urine and faeces touching the baby’s sensitive skin for extended periods of time. Some babies may also develop nappy rash when they start eating solid foods, particularly foods such as citrus, peas and raisins which aren’t as easily digested. Other triggers of nappy rash include diarrhoea, teething, or taking oral TREATMENT OPTIONS Category Examples Comments Barrier creams Soap alternatives Antifungal preparations Antifungal + hydrocortisone combinations Healing/soothing preparations Natural / herbal products / supplements [GENERAL SALE] eg, dimethicone (Silic 15), vitamin A and calamine (Ungvita Cream), zinc and castor oil, zinc and shea butter (Mustela Vitamin Barrier Cream), zinc oxide (Made 4 Baby Botty Barrier Cream, Curash Anti-rash Cream) [GENERAL SALE] eg, Pinetarsol*, Aqueous Cream, DermaLab, Dermaveen, Emulsifying Ointment, Epaderm ointment, QV Gentle Wash [PHARMACY ONLY MEDICINE] eg, bifonazole (Canesten Bifonazole), clotrimazole (Canesten range), miconazole (Daktarin, Resolve), miconazole and zinc oxide (Daktozin) [PHARMACY ONLY MEDICINE] eg, Resolve Plus 0.5% [PHARMACIST ONLY MEDICINE] eg, Canesten Plus, Resolve Plus 1% [GENERAL SALE] eg, Bepanthen Ointment, Kiwiherb Baby Balm, Lucas Papaw ointment, Mustela Cold Cream, Mustela Stelactiv, Sudocrem, Re Gen cream, Weleda Nappy Rash Cream Aloe vera, calendula, chamomile (eg, Kiwiherb Baby Balm), vitamin A, B & E, zinc Products with an asterisk have a detailed listing in the Nappy Rash section of OTC Products, on page 252. Provide a barrier between the baby’s skin and urine and faeces. Apply with each nappy change, after first washing the area with a pH-neutral non-soap cleanser, rinsing and allowing to dry thoroughly. Use instead of soap to wash away urine and faeces from the area, without stripping oils off the skin. Use antifungal creams to treat the fungal infection and continue for one week after the rash has cleared. Use in combination with a barrier cream to protect and soothe the skin. Useful if the skin is particularly inflamed and red, or if there is concurrent dermatitis. Avoid use for longer than one week without seeking further advice. Always use corticosteroids in combination with an antifungal when used in the nappy area. Apply sparingly and change to a formulation without hydrocortisone as soon as possible. Reduce redness, soothe, heal and protect the skin. Most contain a barrier-like agent. Natural products with soothing properties help heal nappy rash. @PharmacyToday. A part of your everyday. New Zealand’s only e-newsletter designed specifically to provide a news snack for pharmacy. With links to you’re only a click away from the full story. Page 110 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION considered a normal part of a human’s bowel flora and is present in faeces. It is usually kept in check by the infant’s immune system and the natural skin barrier. A breakdown in the skin’s barrier may allow the yeast to penetrate and grow unheeded. Nappy rash due to a yeast infection tends to be brighter red than simple nappy rash. There may be small red or white spots around the edge of the rash. The rash often spreads into the skin folds or onto the skin not covered by a nappy. The baby may also have oral thrush, which can sometimes affect a mother’s nipples (see Oral Health). Nappy rash complicated by a bacterial infection Sometimes if a baby’s skin has been irritated and damaged by simple nappy rash it can become infected by bacteria. The skin can be red, warm and swollen and the baby may be very grumpy, cry a lot and develop a fever. Parts of the skin may be broken and weeping, and a yellow crusting may be noticeable. This type of nappy rash needs to be treated by a doctor. Seborrhoeic dermatitis or eczema Rashes in the nappy area may also be caused by seborrhoeic dermatitis, or other skin conditions such as eczema. In these cases, there is also generally a rash somewhere else on the body (see Dermatitis/Eczema). Initial assessment Ask the caregiver for a description of their baby's nappy rash and determine if the baby seems more irritable than usual. Refer any descriptions of moderate to severe nappy rash to the pharmacist. Mild nappy rash can be treated with barrier creams, more frequent nappy changing and nappy-free times. Advise caregivers to use only mild soap-free washes when cleaning baby's bottom and suggest topical antifungal creams if there is evidence of a yeast infection. Advice for customers • Change cloth or disposable nappies as soon as possible when wet or soiled. »» In older children with nappy rash sleeping through the night, consider changing the nappy at least once in the night. • Clean the skin gently to remove any urine or faeces from the area. »» If the baby’s nappy was wet, use warm water to clean. »» If the baby’s nappy was dirty, use a mild soap-free cleanser to clean and rinse thoroughly. »» Baby wipes may sting if the skin is sore (use muslin cloths instead). • Have frequent nappy-free times where the skin is exposed to air and filtered sunlight. • Use a barrier cream or ointment at each nappy change to prevent urine or faeces from coming into contact with damaged skin. »» Barrier creams can be used over the top of antifungal or antibacterial creams. Refer to PHARMACIST The following questions aim to identify customers with babies who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the baby have any other health conditions (eg, immunosuppression)? • Is the baby being given any medicines (particularly antibiotic-type medicines), either prescribed by a doctor or bought from a shop or supermarket (including herbal/complementary medications)? • Does the rash extend beyond the nappy area? • Is there any unusual oozing, blisters, crusting or swelling? • Does the rash look particularly severe? • Has the rash persisted despite previous treatment or has it spread? • Is the rash in other places as well, eg, baby’s mouth, scalp, other skin folds, mother’s nipples? • Has the baby had any prior reactions to topical products? • Talcum powder is no longer recommended for use. It won't protect against nappy rash, can cause friction and irritate a baby's skin, and may be associated with breathing problems and other conditions. • If using cloth nappies, use a nappy liner to keep baby’s skin dry. » » If the nappy rash is particularly bad, consider changing to disposable nappies for a while, or at least at night because these keep wetness away from the baby’s skin more effectively. • Avoid tight-fitting, plastic over-pants. These make the area warm and moist, which is ideal for fungal growth. • Sterilise and rinse cloth nappies meticulously, removing all traces of detergent, and dry in direct sunlight, rather than in a clothes dryer. • If possible, limit intake of any foods that appear to aggravate the condition until the baby is older. Page 111

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