# Nappy Rash (Diaper dermatitis) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Zinc oxide — topical - Nystatin — topical - Clotrimazole — topical - Miconazole — topical - Hydrocortisone — topical ## Complete treatment card ```text NAPPY RASH (DIAPER DERMATITIS) 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) Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Diaper Dermatitis" - disease-level clinical article Status 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 1. ZINC OXIDE [1st line] Adult Apply barrier paste thickly at every diaper change after cleaning - until skin heals Peds Apply thickly at every nappy change after washing and thorough drying 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. Caution 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. Egypt NAPI-CARE OINT. ARAB DRUG COM... 2.35 EGP PENTADIAPER 20% TOPICAL CREAM 30 GM EVA PHARMA > PENTA PHARMA 3.50 EGP BABY RASH FREE 30% OINT. ALEXANDRIA > ... 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 2. NYSTATIN [2nd line] Adult Apply 100,000 units/g cream to the affected area twice daily x 7-14 days (continue 48 hrs after rash resolves) Peds 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. 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. Caution 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. Egypt NOCANDIDA 10 M.I.U. CREAM 20 GM PHAROPHARMA 4.25 EGP 3. HYDROCORTISONE [add-on - not a substitute] Adult Hydrocortisone 0.5% 2 times a day for one week x 1 week Peds 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. 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. Caution 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. Egypt 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 4. CLOTRIMAZOLE [2nd line] Adult Apply the 1% cream or solution thinly to the affected skin twice a day x 7 to 10 days Peds 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. 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. Caution 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. Egypt CANEMAZOLE 1% CREAM 20 GM UP PHARMA 5.00 EGP CANDISTAN 1% TOPICAL CREAM 15 GM KAHIRA > ARAB... 7.25 EGP DERMATIN 1% TOP. CREAM 14 GM PHARCO 15.00 EGP CANESTEN 1% CREAM 20 GM MEMPHIS > BAY... 29.00 EGP LOCASTEN 1% CREAM 20 GM ALEXANDRIA 29.00 EGP CANDISTAN 1% TOPICAL CREAM 40 GM KAHIRA > ARAB... 36.00 EGP ALTERNATIVE TOPICAL AZOLE IF CLOTRIMAZOLE IS NOT TO HAND 5. MICONAZOLE [2nd line] Adult Apply the 2% cream thinly to the affected skin twice a day x 7 to 10 days Peds 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. 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. Caution 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. Egypt 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 PHAR... 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 > ... 28.00 EGP DAKTARIN 2% ORAL GEL 40 GM JANSSEN CILAG... 53.50 EGP ADCOZOLE 2% TOPICAL CR. 15 GM ARAB DRUG COM... 7.25 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)