Nappy Rash

Ireland now has the highest birth rate in Europe and this market for the retail baby category has shown positive growth. Pharmacies have significant advantages over supermarkets, mainly because pharmacy staff can offer advice and expertise that the supermarkets do not offer. Reassure the parent that nappy rash is very common, and at some stage of parenthood, they will be confronted with it. Also make clear that this can occur whether the parent uses washable or disposable nappies. The key here is to clear the nappy rash as soon as possible, and help explain preventative measures to avoid this recurring.

Causes and Symptoms

There are various causes of a nappy rash. Listen (and look if possible) at the rash and explain what type it is, and how to treat it most effectively. There are three types: Nappy Rash When a baby soils or wets itself and the nappy is left on for a longer time than usual, the urine and faeces can encourage the production of the chemical ammonia, which can irritate the baby’s skin, causing it to become sore and inflamed. This is when nappy rash occurs. Where there has been close contact with the nappy, the baby’s skin will look red and inflamed. Most affected will be the genitals, the outer skin on the folds of her thighs, and the bottom. The affected areas can appear either dry or moist, and look shiny or pimply. • The best way to treat this is to keep the bottom as clean and dry as possible and change nappies often. It’s also a good idea to apply a barrier ointment/cream or medicated powder after every change.

Fungal Nappy Rash

Fungal nappy rash is often a complication of initial nappy rash, and looks different. If the baby’s skin is warm and damp for long periods of time, it can cause the fungus ‘candida’, to grow. Like ammonia, candida can irritate the baby’s skin. The area of skin will be inflamed, with spots around the edges. The infection will be bright red and also present in the folds of the skin. To treat a fungal infection, the parent should apply a barrier cream every time the baby’s nappy is changed. Zinc cream, zinc oxide ointment and petroleum jelly are all suitable barrier creams.

• Zinc Oxide works by providing a skin barrier to prevent and help heal skin irritation. • Matricaria Chamomilla (chamomile) is effective in that it is both a demulcent and antibacterial.

• Dexpanthenol (pro-vitamin B5) is an advantageous ingredient in baby care products as it encourages the regeneration of the skin, is a demulcent, activates the lipid synthesis and strengthens the skin’s protective barrier.

Severe Nappy Rash

If a patient’s baby has sever or reoccurring nappy rash, they should be advised to visit their GP as it will usually require prescribed medication. Nappy rash should clear up within a few days of over the counter treatment. There are a number of treatments for severe nappy rash. • Corticosteroids help to reduce the inflammation of the skin and relieve any itching and redness. • Hydrocortisone cream, which should only be applied once a day should not be used for more than seven days • An anticandidal medicine helps to treat any fungal infection that may cause a rash.

Some commonly prescribed anticandidal medicines include: Clotrimazole, econazole, ketoconazole, miconazole and nystatin.

Prevention

Ultimately, prevention is key and, in order to avoid painful nappy rashes, pharmacists should advise parents to follow the same steps involved in treating a mild nappy rash. This involves:

• Leaving the nappy off for as long as possible. • Changing the nappy regularly. • Using only water to wash the baby’s bottom. • Applying a barrier cream after each nappy change. • Tight-fitting plastic pants over nappies should not be used.

• Standard talcum powder should not be used when changing nappies.

Promoting Brands

With women in Ireland bearing an average of 2.1 children each, baby care represents a growing market. In general, product price is not as important within baby care and child-specific products as in other beauty and personal care categories because mothers are prepared to spend more on their babies – they want products that are of the highest quality. The positioning of this category is a vital focus. There are several factors to keep in mind when positioning the baby category; shoppers may often require advice when selecting products therefore endeavour to position the category close to the OTC counter to facilitate this, if it is established that this category is a core category for many of your shoppers ensure that the fixture is clearly visible along the natural path of browsing customers with clear category signage to draw shoppers to the fixture. Consider that young families will need room to browse the fixture if they are shopping with buggies or with small children. Lastly, consider the adjacent categories when positioning baby in order to maximise the opportunity for cross purchase by shoppers.

WWho? Predominantly newborn babies up to age 1 year

WWhat are the symptoms? Nappy rash can affect the genitals, the outer

skin on the folds of the thighs and the buttocks. The affected areas can appear either dry or moist and may sometimes look shiny or pimply

HHow long has the patient had the symptoms? Severe nappy rash or

recurring nappy rash should be referred

AAction already taken? Parents may already be following self-care tips

such as leaving baby’s appy off and changing regularly

MMedication? If baby’s rash is caused by thrush, don’t use a barrier

cream or ointment, as this can make the rash worse

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Septanazal:The nasal spray solution contains xylometazoline hydrochloride and dexpanthenol. Indicated for adults and children over the age of 6 for reducing swelling of the nasal mucosa in rhinitis and as supportive treatment for healing the mucous membrane lesions, for the relief in vasomotor rhinitis and for the treatment of nasal respiratory obstruction after nasal surgery. Adults and children over 6 years of age: The usual dose of Septanazal for adults and children aged 6 years or over is one spray into each nostril up to 3 times a day. Regarding the duration of treatment in children, a doctor should always be consulted. Precautions: This medicinal product may be used only after a careful assessment of the risks and benefits in cases of: patients being treated with the monoamine oxidase inhibitors (MAOIS) and other drugs which potentially increase blood pressure, increased intraocular pressure, especially narrow-angle glaucoma, serious heart and circulatory diseases (e.g., coronary heart disease, hypertension), phaeochromocytoma, metabolic disorders (e.g., hyperthyroidism), porphyria and prostate hyperplasia. In chronic rhinitis it may be used only under medical supervision owing to the danger of the atrophy of the nasal mucosa. The prolonged use and overdose of decongestant sympathomimetics in particular may lead to reactive hyperaemia of the nasal mucosa. This rebound effect causes narrowing of the airways and, consequently, the patient uses the medicinal product repeatedly until its use becomes permanent. The consequences are chronic swelling (rhinitis medicamentosa) or even atrophy of the nasal mucosa. In less severe cases consideration can be given to discontinuing the use of the sympathomimetic in one nostril initially and, after the symptoms have abated, changing to the other side in order to maintain at least part of the nasal respiration. Direct contact of the medicinal product with the eyes should be avoided. In case of misuse or use of excessive amounts of the spray, the absorption of xylometazoline can cause systemic adverse effects, particularly in children (cardiovascular and neurological adverse effects) (see sections 4.8 and 4.9). Concomitant use of the product with medicinal products for local or systemic treatment of the flu and sympathomimetics contained in cough-and-cold medicines (e.g.: pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, xylometazoline, tramazoline, naphazoline, tuaminoheptane) is not recommended in order to avoid an increased risk of possible cardiovascular and neurological adverse effects (see section 4.5). Contraindications: Hypersensitivity to the active substances or to any of the excipients listed in section 6.1 of the SPC, dry inflammation of the nasal mucosa, history of transsphenoidal hypophysectomy or other surgical interventions which expose dura mater. Septanazal for adults is contraindicated in children under 6 years of age. Fertility, pregnancy and lactation: Septanazal should not be used during pregnancy, as there is not sufficient data available concerning the use of xylometazoline hydrochloride by pregnant women. Septanazal should not be used during the lactation period, since it is not known whether xylometazoline hydrochloride is excreted in the breast milk. There is no data on the influence of Septanazal on fertility. Adverse reactions: Uncommon: hypersensitivity. Rare: palpitations, tachycardia, hypertension. Very rare: restlessness, insomnia, fatigue, headache, hallucinations, rebound congestion, nosebleed, convulsions. Not known: burning and dryness of nasal mucosa, sneezing. Shelf life: 2 years. Legal category: Medicinal product not subject to medical prescription. Marketing authorisation number: PA1347/058/002. Marketing authorisation holder: Krka, d. d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia. http://www.hpra.ie/img/uploaded/swedocuments/LicenseSPC_PA1347-058-002_19012017142039.pdf Date of Preparation: October 2017. Additional information is available on request from Krka Pharma Dublin Ltd. Unit 4A, Leopardstown Business Centre, Ballyogan Road, Leopardstown, Dublin 18. D18 KX88. Reference number: 01-11-2017. * Passàli D, Salerni L, Passàli GC et al. Nasal decongestants in the treatment of chronic nasal obstruction: efficacy and safety of use. Expert Opinion on Drug Safety 2006; 5(6): 783–90.