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