I am Dr Shamoon. Your grandmother's problem is classic incontinence-associated dermatitis with a superadded candidal (fungal) infection - the swollen labia, severe rash at the anal opening, skin that is drying and flaking again, plus constant moisture from urine and 1-2 hourly diaper changes make this the most likely picture. Two things are driving it: (1) the diuretic she is taking for leg swelling causes excessive urine, so the skin is almost never dry, and (2) the recent loose motions plus bed rest after thigh surgery. Sudocrem alone is not enough here - it is a barrier cream and does not treat yeast, which is why the rash keeps returning. At 85, bedridden, 16 days post thigh surgery, there are two further risks I want you to be alert to: this raw area can become a pressure sore or a bacterial cellulitis, and her
sugar levels must be checked, since undiagnosed or borderline
diabetes is very common at this age and keeps such rashes going. Her inability to bend the thigh is expected after surgery, but the skin condition is treatable at home and does not need her to travel to a hospital right now.
Next Steps
1. Change the diaper the moment it is wet, and each time clean with plain lukewarm water or a soft cloth - no soap, no wipes with alcohol or fragrance. Pat dry, never rub, and let the area stay open to air for 15-20 minutes 3-4 times a day. 2. On the raw and flaking area apply a topical antifungal - clotrimazole 1% or miconazole 2% cream - thinly, twice a day for 2 weeks, and continue for a week after the rash clears. 3. After the antifungal has absorbed, put a thick barrier layer of zinc oxide paste or Sudocrem over it. Antifungal first, barrier on top - that order matters. 4. Use only breathable, correctly sized diapers, and switch to underpads/absorbent sheets when she is in bed so the skin gets diaper-free time. 5. Turn her side to side every 2 hours to prevent pressure sores over the sacrum and hips - very important since she is bedridden after the thigh surgery. 6. Ask her treating doctor whether the diuretic dose can be given in the morning rather than at night, or reduced - this alone will cut down night-time wetting. Do not stop it yourself. 7. Get a random blood
sugar and
HbA1c done at home by a sample-collection service; also a urine routine test, since burning or foul urine may mean a UTI. 8. Keep her well hydrated and give curd/probiotic to settle the gut after the loose motions. 9. A home visit by a doctor or a home-care nurse can be arranged in Delhi - she does not need to be moved for this. 10. You may consult me on Practo with a photograph of the rash for a specific plan, or, if you are ever near Miraj, at Synergy Multispeciality Hospital.
Health Tips
Caution: do not apply steroid creams or powders on the raw area, and do not start antibiotics without advice - at 85 they can worsen her stomach and cause resistance. Seek urgent medical review if the skin becomes deep red and hot with fever, if there is pus, foul smell, a blackish or open ulcer, if she becomes drowsy or confused, or if the operated thigh becomes swollen, red or painful.