Diaper Dermatitis
Continuity Clinic
Objectives
• Be able to identify common infant diaper
rashes
• Understand the factors involved with
causing irritant diaper dermatitis
• Know how to treat the common diaper
rashes
Continuity Clinic
Epidemiology
• 1990-1997: 4.8 million outpatients visits
– 75% of these in pediatric offices
• Peak ages: 9-12 months
• Often associated with Candida albicans
– Higher severity associated with C. albicans
Continuity Clinic
Factors Involved in Development
• Combination of:
–
–
–
–
Diaper occulsion
Fecal enzyme activity activity
Urine
Diaper chaging
• Leads to:
– Overhydration of the stratum corneum
– Chemical and mechanical abrasion
– Susceptibility to penetration of irritants and microbes
Continuity Clinic
Role of Urine and Feces
• Interaction of urine and feces is
fundamental in the development of IDD
(Irritant Diaper Dermatitis)
• Bacterial ureases in stool degrade urea in
urine thus releasing ammonia
– Ammonia does not irritate skin but increases
local pH which reactivates fecal enzymes
such as lipase and protease which irritate skin
Continuity Clinic
Differential Diagnosis
• Inflammatory
–
–
–
–
–
–
–
Contact Dermatitis
Allergic Dermatitis
Intertrigo
Seborrheic Dermatitis
Atopic Dermatitis
Psoriasis
Granuloma gluteale infantum
• Malignancy
– Langerhans’ cell histiocytosis
• Miscellaneous
– Miliaria
– Child Abuse
Continuity Clinic
• Infectious
–
–
–
–
Candidiasis
Folliculitis
Bullous impetigo
Perianal/Intertriginous
streptococcal disease
– HSV
– Scabies
– Congenital Syphilis
• Nutritional/Metabolic
– Acrodermatitis enteropathica
– Biotin Deficiency
– Cystic Fibrosis
Characteristics
• Irritant Diaper Dermatitis
– Confluent erythematous papules
– Scaling
– Skin Folds Spared
• Candidiasis Associated
– Rash > 3 days
– Irregular, scaly border
– Satellite lesions
– Skin Folds involved
Continuity Clinic
You Guess the Diagnosis!
Continuity Clinic
Continuity Clinic
Irritant Diaper Dermatitis
Spares skin
folds
Continuity Clinic
Continuity Clinic
Candidiasis
In folds of
skin
Continuity Clinic
Satellite
lesions
Continuity Clinic
Bullous Impetigo
Continuity Clinic
Note erosions
of skin
Continuity Clinic
Streptococcal Intertrigo
Continuity Clinic
Management of IDD
• Nonmedical
– Frequent diaper changes
– Gentle cleansing
– Barrier protection
• Medical
– Anti-inflammatory  low potency steroids
– Anti-fungal  lotrimin, nystatin
Continuity Clinic
Commonly Used Barrier Creams
ACTIVE INGREDIENTS
•
•
•
•
•
•
•
•
Vitamin A&D ointment
Aquaphor
Aveeno diaper cream
Balmex ointment
Boudreaux’s paste
Desitin
Triple Paste
Zinc Oxide ointment
Continuity Clinic
Vit. A & D, lanolin
Petrolatum, lanolin
Zinc oxide, dimethicone
Zinc oxide
Zinc oxide
Zinc oxide
Petrolatum
Zinc oxide
Cleansing
• Avoid wipes with alcohol product
• Nonirritating cleansers: cetaphil or mineral oil
• Do not entirely wipe away barrier preparation –
wipe away feces and replace what barrier is
removed
• Powders?
– Cornstarch is recommended over talcum powder
– Talcum powder associated with severe respiratory
distress caused by inhalation
Continuity Clinic
Corticosteroid Use
• Low potency steroids relatively safe
• Mid to High Potency corticosteroids
– Generally contraindicated in occluded areas
of the skin and can cause skin atrophy, striae,
tachyphylaxis, and growth delay
– Abraded skin also increases absorption rates
Continuity Clinic