chronic

Nappy Rash (Diaper dermatitis)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

NICE Clinical Knowledge Summaries Nappy Rash 2021 · No labelled dose - barrier preparation applied to intact skin, to effect · Egyptian National Drug Formulary, antimicrobial 2023, nystatin monograph, topical mucocutaneous candidiasis · Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) · Diaper Dermatitis - StatPearls - NCBI Bookshelf (NBK559067), with the form and indication from Egyptian National Drug Formulary - Antimicrobial 2023 (miconazole monograph)

Verified against3 documents

No labelled dose - barrier preparation applied to intact skin, to effect
Egyptian National Drug Formulary, antimicrobial 2023, nystatin monograph, topical mucocutaneous candidiasis
Nappy Rash (Diaper dermatitis) - disease-level clinical article (nappy-rash-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

Looser or more frequent stools often precede the rash by about two days [rash]

Signs — what you find (5)

Erythema, papules, scaling, and erosions appear over the thighs, scrotum, and buttocks, sparing the skin folds [papules · redness · scaling]
Satellite pustules or papules are the most characteristic sign of candidal involvement [papules · pustules]
Candidal dermatitis shows scaly, edematous erythema and can extend into the skin folds [redness · scaling]
S. aureus infection ranges from small pustules to the fragile blisters of bullous impetigo [blisters · pustules]
S. pyogenes causes bright red, macerated skin involving the folds

Tests (3)

No laboratory testing is generally required for this clinical diagnosis
A KOH prep can confirm suspected Candida albicans, though it isn't required
Gram staining can be done when bacterial infection is suspected

If not this — what else fits (4)

Seborrheic dermatitis begins on the scalp and face in the first month and can spread to the diaper area
Atopic dermatitis at 3 to 12 months affects flexural creases and usually spares the diaper area
Allergic contact dermatitis follows a new product and stays where it was applied
Other mimics include tinea cruris, scabies, acrodermatitis enteropathica, and congenital syphilis

SourceStatPearls "Diaper Dermatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Topical azole when nystatin has not cleared it | Alternative topical azole if clotrimazole is not to hand

MAIN TREATMENT - choose one, plus any add-on marked below

ZINC OXIDE

1st line

Formtopical

Adult dose and duration

Apply barrier paste thickly at every diaper change after cleaning - until skin heals

Paediatric dose

Apply thickly at every nappy change after washing and thorough drying

Dose source

No labelled dose - barrier preparation applied to intact skin, to effect

Why

Barrier protectant applied to shield irritated skin from the moisture and friction of nappies; first-line management for uncomplicated nappy rash.

Cautions

First line management is frequent nappy changes, nappy-free time, and gentle cleansing with water.
Avoid alcohol wipes and scented soaps.
If satellite lesions or persistent rash >3 days, suspect secondary Candida infection.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NAPI-CARE OINT.	ARAB DRUG COMPANY (ADCO)	2.35 EGP
PENTADIAPER 20% TOPICAL CREAM 30 GM	EVA PHARMA > PENTA PHARMA	3.50 EGP
BABY RASH FREE 30% OINT.	ALEXANDRIA > MILLENIUM PHARMA-EGYPT	5.00 EGP
EVA BABY CARE CREAM 50 GM	EVA PHARMA	9.75 EGP
BALMIX 10% CREAM 30 GM	SIGMA	14.40 EGP
NONOPENT CREAM 75 GM	> PENTA PHARMA	100.00 EGP
NINO SERENO CREAM	EL NILE > GMCKS	120.00 EGP

NYSTATIN

2nd line

Formtopical

Adult dose and duration

Apply 100,000 units/g cream to the affected area twice daily x 7-14 days (continue 48 hrs after rash resolves)

Paediatric dose

Apply the 100,000 units/g cream twice daily under a barrier cream for candidal nappy rash, 7-14 days, continuing 48 hours past the rash clearing.

Dose source

Egyptian National Drug Formulary, antimicrobial 2023, nystatin monograph, topical mucocutaneous candidiasis

Why

Topical polyene antifungal that binds fungal cell membrane sterols, used when nappy rash develops the beefy red, satellite-pustule appearance of secondary candidal infection.

Cautions

Indicated for candidal diaper dermatitis (beefy red rash, involvement of skin folds, satellite pustules).
Apply antifungal first, then barrier paste over it.
Exclude oral thrush which may re-infect digestive tract.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NOCANDIDA 10 M.I.U. CREAM 20 GM	PHAROPHARMA	4.25 EGP

HYDROCORTISONE

add-on - not a substitute

Formtopical

Adult dose and duration

Hydrocortisone 0.5% 2 times a day for one week x 1 week

Paediatric dose

Apply Hydrocortisone 0.5% 2 times a day for 1 week for moderate-to-severe diaper dermatitis or when barrier measures fail after 2-3 days.

Dose source

Nappy Rash (Diaper dermatitis) - disease-level clinical article (nappy-rash-clinical.txt)

Why

Short course of low-potency topical corticosteroid to reduce inflammation in moderate-to-severe diaper dermatitis or when non-pharmacologic barrier measures fail after 2-3 days.

Cautions

Use low-potency formulations (e.g. 0.5%) for a short duration (maximum 7 days) to avoid skin atrophy and systemic absorption.
Do not use under tight-fitting diapers or occlusive dressings without medical supervision.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
NOVACORTIN 1% CREAM 15 GM	PHAROPHARMA	4.75 EGP
NOVACORTIN 1% OINT. 15 GM	PHAROPHARMA	4.75 EGP
MICORT 1% CREAM 20 GM	MISR	12.50 EGP
HYDROCORTISONE 1% OINT. 20 GM	MISR	21.00 EGP

TOPICAL AZOLE WHEN NYSTATIN HAS NOT CLEARED IT

CLOTRIMAZOLE

Topical azole when nystatin has not cleared it

2nd line

Formtopical

Adult dose and duration

Apply the 1% cream or solution thinly to the affected skin twice a day x 7 to 10 days

Paediatric dose

The child is the patient here. Same twice-daily application for 7 to 10 days; apply thinly and leave the area open to air where you can.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (clotrimazole monograph) - verbatim: "Cutaneous candidiasis: Topical: Cream, solution: Apply to affected area twice daily; if no improvement occurs after 4 weeks of therapy, re-evaluate diagnosis."; the 7 to 10 day course is from Diaper Dermatitis - StatPearls - NCBI Bookshelf (NBK559067)

Why

Candida colonises broken nappy skin, and the article says to move to an azole when nystatin has not helped within a few days. Clotrimazole is the cheapest and most widely stocked plain azole cream in Egypt.

Cautions

Reconsider the diagnosis if the rash has not improved by the end of the course - a persisting nappy rash may be psoriasis, seborrhoeic dermatitis, scabies or bacterial infection rather than candida.
Do not use if the child has reacted to a topical azole before.
Prescribe the plain cream, not a betamethasone-clotrimazole combination - a potent steroid under an occlusive nappy thins the skin.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CANEMAZOLE 1% CREAM 20 GM	UP PHARMA	5.00 EGP
CANDISTAN 1% TOPICAL CREAM 15 GM	KAHIRA > ARAB DRUG COMPANY (ADCO)	7.25 EGP
DERMATIN 1% TOP. CREAM 14 GM	PHARCO	15.00 EGP
CANESTEN 1% CREAM 20 GM	MEMPHIS > BAYER HEALTHCARE	29.00 EGP
LOCASTEN 1% CREAM 20 GM	ALEXANDRIA	29.00 EGP
CANDISTAN 1% TOPICAL CREAM 40 GM	KAHIRA > ARAB DRUG COMPANY (ADCO)	36.00 EGP

ALTERNATIVE TOPICAL AZOLE IF CLOTRIMAZOLE IS NOT TO HAND

MICONAZOLE

Alternative topical azole if clotrimazole is not to hand

2nd line

Formtopical

Adult dose and duration

Apply the 2% cream thinly to the affected skin twice a day x 7 to 10 days

Paediatric dose

The child is the patient. Twice-daily application for 7 to 10 days. Use the skin cream on the nappy area, not the oral gel.

Dose source

Diaper Dermatitis - StatPearls - NCBI Bookshelf (NBK559067), with the form and indication from Egyptian National Drug Formulary - Antimicrobial 2023 (miconazole monograph)

Why

Interchangeable with clotrimazole for candida nappy rash and just as cheap in Egypt. Useful when a breastfed pair is already using miconazole in the mouth, since the same 2% strength treats the skin.

Cautions

Reconsider the diagnosis if the rash has not settled by the end of the course.
Do not use if the child has reacted to a topical azole before.
Prescribe plain miconazole cream rather than the hydrocortisone-miconazole combination for occluded nappy skin.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MICONOL 2% CREAM 15 GM	MEMPHIS	5.00 EGP
DERMOZOL 2% GEL 15 GM	PHARCO	6.00 EGP
MICO ORAL 2% ORAL GEL 30 GM	ALFACURE PHARMACEUTICALS	6.25 EGP
BUCCAZOLE 2% ORAL GEL 20 GM	PHARCO	12.00 EGP
MICONAZ 2% ORAL GEL 20 GM	MUP	23.00 EGP
DAKTARIN 2% CREAM 15 GM	MINA PHARM > JANSSEN CILAG	28.00 EGP
DAKTARIN 2% ORAL GEL 40 GM	JANSSEN CILAG > SOFICOPHARM	53.50 EGP
ADCOZOLE 2% TOPICAL CR. 15 GM	ARAB DRUG COMPANY (ADCO)	7.25 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.