An MS skin saviour

Ian Cook on why MSers are never too old to get ‘nappy rash’, especially as the weather heats up

Nappy rash, sweat rash or to use the medical term, ‘intertrigo’, is a common problem as multiple sclerosis (MS) advances, something I know only too well.

I’m talking about a red itchy inflammation of the skin which you usually see in areas where skin rubs on skin, such as in your groin, armpits, and between skin folds. Intertrigo occurs most often in what medics call the ‘perineum’, the area between your legs.

Mobility issue

MS-related intertrigo occurs most often in people with more advanced MS, who, like me, have limited mobility. Wheelchair users are particularly at risk. As well as immobility, other risk factors include incontinence (pee and poo), self-catheterising, being overweight, using corticosteroids, and excessive sweating.

Intertrigo is mainly brought on by warm temperatures, friction or rubbing, moisture and/or sweating. Poor hygiene and poor ventilation are risk factors too. Intertrigo typically starts as a red rash in skin folds that itch, sting or burn. If a secondary infection occurs, which can be due to yeast (candida) and/or bacteria, skin becomes inflamed, and in extreme cases if left untreated a foul-smelling discharge can develop.

My first experience of intertrigo came after I went to an NHS walk-in centre following a urinary tract infection. After walking in, I signed the book and sat down in a small plastic seat, in a cramped, sweaty and poorly ventilated room. I waited, waited and waited for several hours. After something like five hours I was called in to see the doctor who prescribed the antibiotic nitrofurantoin.

It was only after I rollated over the road to the pharmacist that I realised my groin was really painful. On returning home that evening I inspected the affected area and was surprised to see a red, itchy patch about three inches square around the top of one leg. I remember being surprised that there was a sharp boundary between the red, inflamed, area and the unaffected skin. What struck me most was that the inflamed area itched and itched. The ‘inflamed’ area really did feel like it was on fire.

An easy fix

After a rather uncomfortable night’s sleep, I rather sheepishly made my way to the local pharmacist where I explained my problem. The female pharmacist asked to have look, which she did in the pharmacy consulting room, and I remember her words. “You’ve got nappy rash,” she said. She then produced a 400g tub of something called Sudocrem, an antiseptic and anti-fungal healing cream which cost me about £5.

I went home and smeared the Sudocrem liberally over the affected area. Within hours the itch was gone and within a couple of days the redness had totally disappeared. It has returned a couple of times, usually when I have been sitting for very long periods in hot sweaty places like waiting rooms but fortunately, I have always been able to ‘nip the problem in the bud’ by slapping on the Sudocrem.

Game-changing cream

In case you were wondering Sudocrem is a thick cream containing lanolin, zinc oxide and paraffin. Lanolin acts as an emollient (something that soothes and softens the skin) zinc oxide reduces the loss of fluid and acts as an antibacterial, and paraffin repels fluid and creates a protective seal over the skin.

If you start to suffer from intertrigo or nappy rash, then my advice is to go promptly to the pharmacist and get yourself a tub. It really is a game changer or has been for me. Fortunately, I have always been able to act promptly and never had secondary infections like foul-smelling discharges. However, if a secondary infection does occur it’s possible to get antibiotics and/or stronger antifungals to treat the infection.

Preventative measures

The pharmacist also told me that personal hygiene is an issue too. This means more washing, better drying and reducing friction between the skin fold. You can also wear loose clothes that allow ventilation and change your underwear more frequently. And if you self-catheterise several times daily, as I do, it’s important to make sure you properly dry yourself afterwards.

Other things you can do is try and lose weight if you are overweight because excess folds of skin are a perfect breeding ground for intertrigo. If you suffer from excessive sweating, try using an antiperspirant. Yes, you can use the same antiperspirants for your armpits in your groin and skin folds. Some products are marketed specifically for the groin but are more expensive.

Period drama

And, in case you were wondering, intertrigo isn’t just a problem for us unhygienic males. It also affects women, particularly surrounding menstruation due to sanitaryware.

The takeaway message I suppose is that if you have MS, you’re never too old to suffer from nappy rash, and there are solutions, well, creams, which work a treat. My advice to fellow prog-MSers is go out and get some Sudocrem now. It’s only about £5 and you never know when you might need it.