REFERAT

DEPARTMENT DIAGNOSTIC AND TREATMENT

DERMATO – VENEREOLOGIST OF DIAPER RASH

FACULTY OF MEDICINE Disusun oleh :

UNIVERSITAS AL-KHAIRAAT Elpis Husain & Azizah A. Alkatiri
12 16 777 14 136 12 16 777 14 137
PALU
2017 Supervisor :
dr. Nur Rahma, M.Kes, Sp.KK
 DEFINITION

Nappy dermatitis (also known as Diaper Rash, nappy

rash, diaper dermatitis or irritant diaper dermatitis) is a
general term used to describe an irritant inflammatory skin
reaction in the nappy area, as a result of one or more factors:
urine, faeces, moisture or friction. Diaper dermatitis is one
of the most common dermatologic conditions in infants
and children, noted in approximately 1 million pediatric
outpatient visits each year.

Chang, M.W., dan S.J Orlow. Neonatal, Pediatric ,and Adolescent Dermatology dalam Fitzpatrick’s
Dermatology in General Medicine (edisi ke-7). USA: McGrawHill, 2008) pg. 1197-1197
 EPIDEMIOLOGY

• In one survey of 1089 infants, diaper dermatitis occurred in

50%; however, only 5% had severe rash. The peak incidence of
diaper dermatitis is between 9 and 12 months of age.
• The prevalence of nappy rash has been found to vary from
country to country, ranging from 15% in Italy, 16% in UK,
43.8% in China, 75% in US and 87% in Japan.
Cont”

One large UK population study showed that 25% of children had

experienced nappy rash during the first 4 weeks of life and another
study reported that 52% of children, ranging from preterm infants
to children > 24 months of age, had experienced an episode.
 ETIOLOGY
Many factors play a role on diaper dermatitis etiology.
1. Maceration by water
2. Friction
3. Urine
4. Faeces
5. Microorganisms
6. Nutritional factors
7. Chemical irritants
8. Diarrhea
9. Antibiotics
10. Developmental abnormalities of the urinary tract

Burns.T, D. J., Gennery, A. R., & Cant, A. R. (2004). The Neonate. Diaper Dermatitis. In S.
Breathnach, N. Cox, & C. Griffiths, Rook's Textbook of Dermatology (pp. 17.22-17.26). Massachusetts:
Blackwell Sciences. London: Blackwell Publishing.
 PATHOPHYSIOLOGY

The main irritants in this situation are fecal proteases and

lipases, whose activity is increased greatly by elevated pH. An
acidic skin surface is also essential for the maintenance of the
normal microflora, which provides innate antimicrobial protection
against invasion by pathogenic bacteria and yeasts. Fecal lipase
and protease activity is also greatly increased by acceleration of
gastrointestinal transit; this is the reason for the high incidence of
irritant diaper dermatitis observed in babies who have had diarrhea
in the previous 48 hours.
 CLINICAL MANIFESTATION

• Irritant contact dermatitis begins as acute : erythema on the

convex skin surfaces of the pubic area and buttocks with sparing
of the skin folds, reflecting the areas of the body in most contact
with the diaper  It’s seen mostly between 3-12 weeks
• S. aureus infection presents as bullous impetigo, characterized
by scattered vesicles, bullae and denuded areas of skin, while
group A streptococcus presents as an erythematous patch
perianally
• Coxsackie virus causes  erythematous papules on the buttocks,
palms and soles and ulcers in the posterior pharynx.
 Different degrees and types of
diaper rash

• SLIGHT
This baby has some faint pinkness in the diaper area.
Cont”

• MILD
This baby has an area of pinkness and a few raised bumps.
Cont”

• MODERATE

This baby has definite pinkness in a large area with some small
areas of definite redness. There are also scattered, raised
bumps (papules).
Cont”

• MODERATE TO SEVERE

This baby has intense redness, peeling, raised bumps (papules)

and a few fluid-containing bumps (pustlues).
Cont”

• SEVERE

This baby has intense redness and large ares of multiple raised
bumps (papules) as well as fluid-containing bumps (pustules).
 DIAGNOSTIC

• Anamnesis
• Physical examinations
• Laboratory examination
- Whole Blood
- KOH 10%
- Histophatology
 DIFFERENTIAL DIAGNOSTIC

1. Infantile Seborrhoeic Eczema

Infantile seborrhoeic eczema starts

in the first few weeks of life and
tends to affect the body folds,
including the axillae, groin and
neck, but it also may involve the
face and scalp

Flexural lesions present as moist,

shiny well demarcated scaly
erythema, but on the scalp a
yellowish crust is often found.
Cont”

2. Candidiasis

Erythema, scaling and

pustules are seen, often
involving the flexures, and
there may be satellite
lesions.
Cont”

3. Napkin Psoriasis

The rash consists of plaque

form of psoriasis in the
diaper area accompanied
by satellite papules, bright
red plaque bordered, not
scaly.
 TREATMENT

Chang, M.W., dan S.J Orlow. Neonatal, Pediatric ,and Adolescent Dermatology dalam Fitzpatrick’s
Dermatology in General Medicine (edisi ke-7). USA: McGrawHill, 2008) pg. 1197-1197
 PREVENTION

• Change diapers often. Remove wet or dirty diapers

promptly. If your child is in child care, ask staff members to
do the same.
• Rinse your baby’s bottom with warm water as part of each
diaper change. You can use a sink, tub or water bottle for
this purpose. Don’t use wipes with alcohol or fragrance. If
you wish to use soap, select a mild, fragrance free type.
• Gently pat the skin dry with a clean towel or let it air dry.
Don’t scrub your baby’s bottom. Scrubbing can further
irritate the skin.

Mayo. C. 2017. Prevention. Diaper Rash – Sumptoms and causes-Mayo clinic.

Cont”

• Consider using ointment regularly. If you baby gerts

rashes often, apply a barrier ointment during each diaper
change to prevent skin irritation. Petroleum jelly and zink
oxide are the time proven ingredients in many diaper
ointments.
• Aften changing diapers, wash your hands well. Hand-
washing can prevent the spread of bacteria or yeast to
other parts of your baby’s body, to you or to other children.

Mayo. C. 2017. Prevention. Diaper Rash – Sumptoms and causes-Mayo clinic.

 COMPLICATION

1. Jacquet erosive diaper rash

2. Granuloma gluteal infantum
 PROGNOSIS

Primary irritant napkin dermatitis will almost always show

some response to therapy, and, in the longer term, it will
resolve when napkins are no longer worn. However, in some
children the napkin area eruption is merely the fi rst sign of a
susceptibility to chronic skin disorders, particularly psoriasis
and atopic dermatitis. Since atopic dermatitis often initially
presents with a napkin dermatitis indistinguishable from simple
primary irritant napkin dermatitis, one has to be cautious not to
give too optimistic a prognosis to parents of any child with
such a rash
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YOU