TEACHING CASE
MONIKA BHAGAT PL-1
DIAPER DERMATITIS
Diaper rash is a general term describing any of the inflammatory skin conditions
that occur in the diaper area.
CLASSIFICATION:
Rashes directly or indirectly caused by wearing of diapers:
Irritant Contact dermatitis
Candida diaper dermatitis
Granuloma gluteal infantum
Rashes that appear elsewhere s but exaggerated in the groin area
Atopic dermatitis
Seborrheic Dermatitis
Psoriasis
Rashes that occur irrespective of the diaper use
Bullous impetigo
Langerhans cell histiocytosis
Acrodermatitis enteropathica
Congenital syphilis, Scabies, HIV
EPIDIMIOLOGY:
Starts in the neonatal period as soon as the child starts wearing
diapers.
Incidence peaks between 7-12 months
Stops being a problem once child is potty trained
In US prevalence has been reported between 4-35% in first 2 years of
life.
PATHOGENESIS:
Wetness
Friction
Urine & Feces
Microorganisms
wetness
Hydration &
maceration
RASH
of st.
corneum
Enhanced Impaired
epidermal barrier
penetration function
Bacterial
urease in
feces
degrades
urea found in
urine
Liberation
RASH
of ammonia
Increased
local ph
Irritation &
contributing
disruption of
to activation
epidermal
of fecal
barrier
proteases &
lipases
RISK FACTORS:
Fecal incontinence & diarrhea
H/o Atopic dermatitis
Cow’s milk formula fed infants
Soaps, detergents, antiseptics
DIAGNOSIS:
Irritant diaper dermatitis
Usually follows a bout of diarrhea
Mostly asymptomatic
Lasts < 3 days after diaper changing practices are initiated.
P/E :
localized asymptomatic local erythema eventually progressing to painful confluent
erythema with maceration, erosions and frank ulcerations.
Commonly spares the skin folds, effects the convex skin surfaces in contact with
diaper .
IRRITANT CONTACT DERMATITIS
Candida diaper dermatitis:
Should be suspected in all rashes lasting > 3 days despite following the diaper changing
practices.
Painful
May follow recent antibiotic use.
Beefy red plaques and satellite pustules and papules
Intertriginous areas prominently involved.
Secondary bacterial infections:
Associated fever, pustular drainage, lymphangitis
Erythema, edema, tenderness, purulent discharge
Granuloma gluteale infantum:
Violaceous papules and nodules on buttocks and groin.
Resistant to treatment with barriers, steroids and antifungals.
Self limited, resolves in weeks and months with residual scarring
Candida diaper dermatitis
STAPHYLOCOCCAL INFECTION
Granuloma gluteale infantum
Atopic dermatitis:
Family or past h/o allergic rhinitis/ asthma/hay fever
Pruritis
Current/ previous flares of rash on face or extensor limb surfaces.
Discrete and confluent excoriated red papules.
Seborrheic dermatitis:
infants between 2 weeks to 3moths
Typically associated with seborrheic dermatitis of scalp, face, post auricular areas.
Salmon colored lesions with yellow scales.
prominent in intertriginous areas.
Psoriasis
Erythmatous scaly eruption in diaper area.
Inguinal folds typically involved
Thick silvery scales usually not seen.
May involve scalp, trunk, extremities, nails.
Clinically indistinguishable from seborrheic diaper dermatitis.
Seborrheic dermatitis
Psoriasis
Proriasis
Langerhans cell histiocytosis:
Severe hemorrhagic diaper dermatitis unresponsive to any treatment.
May have associated diarrhea, anemia, lymphadenopathy, hepatospleenomegaly.
Acrodermatitis enteropathica
Erythematous well demarcated scaly plaques and erosions.
Typically involves perioral, perineal and acral areas.
May have associated diarrhea, hair loss or a predisposition for malabsorption like
cystic fibrosis or malnutrition.
Acrodermatitis enteropathica
langerhans cell histiocytosis
PREVENTION:
A: Fresh Air
B: Barriers
C: Cleansing
D: Diapers
E: Education
TREATMENT:
Zinc oxide
Antiseptic and astringent
Wound healing
Low risk of allergies and contact dermatitis.
Petroleum ointment
Safest otc emollient.
Acts by trapping water beneath the epidermis
Steroids
For moderate to severe IDD.
Hydrocot 1% ointment applied for limited duration.
Moderate to high potency steroids never used.
Antifungals
Presumably treat diaper dermatitis rash lasting for > 3 days with topical antifungals.
Nystatin cream/ clotrimazole 1%/ miconazole 2% ointment.
If significant inflammation + , 1% hydrocortisone cream for initial 1-2 days.
Avoid higher strength steroid combinations like nystatin/ triamcinolone, clotrimazole/ betamethasone.
THANK YOU
