Questionnaire/history: History from? Location of rash? Nature? Duration? Risk factors? - Skin care practices (eg how often area cleaned and nappy changed)? - Type of nappy (eg disposable or reusable cotton nappies)? - Chemical irritants (eg soaps, detergents or alcohol-based baby wipes)? - Skin trauma (eg friction from nappies or over-vigorous cleaning)? - Medication (eg recent broad-spectrum antibiotic)? - Gestational age (eg pre-term)? - Diarrhoea? Past medical history? Current medication? Previous treatments? Drug allergies? Examination: Child appeared distressed, agitated or uncomfortable? Features of rash? - Well-defined of confluent erythema? - Scattered papules over convex surfaces in contact with the nappy? - Sparing of the inguinal skin creases and gluteal cleft? - Glazed if acute or fine scaling if longstanding? - Severe (eg skin erosions, oedema, ulceration)? Candidal secondary infection? - Sharply marginated bright red patches or plaques? - Confluent zones of papules and pustules spread into the skin folds? - 'Collarettes' of scale and satellite lesions? Bacterial secondary infection? - Marked redness with exudate? - May be papules, pustules, blisters, folliculitis or abscess if severe? Investigations: - Consider swab if bacterial infection suspected, esp. if severe? Management Reference(s): NICE CKS: Nappy rash Information for parents/carers: NHS Health A to Z: Nappy rash Patient UK: Nappy rash