Avoid hot water, prolonged soaking, bubble baths, talcs and perfumed soaps and alcohol-based wipes. If the skin becomes wet with urine, washing with warm water may be adequate. Gently pat the skin dry; avoid rubbing. If no urine has been in contact with the skin, washing at every pad change is unnecessary. Emollients and foam cleansers can be beneficial for dry, scaly skin as a soap substitute and to remove old layers of cream.
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- assess the incontinence - can the condition be improved?
- ensure adequate fluid intake and healthy diet
- exclude urinary-tract infection
- assess the requirement for incontinence pads
- avoid plastic pants.
There are many preparations available but little published evidence to inform a choice. Consider safety, efficacy, cost-effectiveness and patient acceptability. Barrier preparations should be applied sparingly to the affected area only; excessive use can cause maceration, increasing the risk of microbial infection. Creams should be used with caution or avoided when incontinence pads are required as they may impair absorption
Treatment of active inflammation usually includes a topical antifungal, eg clotrimazole 1%, perhaps combined with a topical steroid eg Canesten HC®. See section 13.4.
Nappy rash is a form of incontinence dermatitis and the guidance above also applies in this condition. In particular the following measures should be taken:
- increase the frequency of nappy changing and cleansing the skin
- apply a barrier cream after every nappy change
- let the child spend as long as possible without a nappy on.