Bacterial or viral infections in the nappy area

Pustules, erosions, ulcers or weeping in the nappy area may indicate a bacterial or viral infection. Staphylococcal infections are common, and can spread rapidly in the warm, moist nappy environment. Herpes simplex virus infection causes painful grouped ulcers and erosions (the vesicular phase is often brief), and oedema is often prominent.

If infection is suspected (particularly when the response to irritant nappy rash treatment is inadequate), take a swab of the area to confirm the diagnosis.

If staphylococcal infection is identified, treat localised and widespread infections as for infected atopic dermatitis.

For mild herpes simplex virus infection, no treatment is required because the lesions heal within 2 weeks. For severe herpes simplex virus infection, with ulceration or urinary retention, refer the patient to the hospital emergency department. The patient may need to be admitted to hospital for intravenous aciclovir. See also Herpes simplex virus infections.