DEPARTEMENT OF DERMATOVENEROLOGY REFERAT

FACULTY OF MEDICINE JANUARY 2020

HASANUDDIN UNIVERSITY

NAPKIN ECZEMA
Muhammad Hazim Hazlami Bin Haron C014182172
Muhammad Syafiq Izuddin Bin Azman C014182173
Muhammad Rusydi Bin Ropli C014182175
Ade Nusraya C014182153
Nurul Shafinaz Izlin Binti Mat Mukti C014182176
Husna Nabila Binti Mohd Hisam C014182213
Resident
dr. Anita Indah

Supervisor
dr. Muhlis, Sp.KK, M.Kes
 Introduction
Napkin eczema (diaper dermatitis) is common skin
problem in infants.

Multiple factors contribute to the development of

diaper dermatitis.

Prolonged exposure to moisture results in increased

frictional damage, decreased barrier function , and
increased reactivity to irritants.

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 Definition
Diaper dermatitis or napkin eczema is a nonspecific
term used to describe any of the various inflammatory
reactions of the skin within the diaper area, including
the buttocks, perianal area, genitals, inner thighs and
waistline.

Maja S, Uros M, Natasa M; 2017; Diagnosis and Management Of Diaper Dermatitis in Infants With Emphasis On
Skin Microbiota In The Diaper Area; International Journal of Dermatology; 1.

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Anatomy
Physiology of skin
Protection
Absorption
Excretion
Perception
Regulation of body temperature
Manufacture melanin
Vitamin D synthesis
Keratinization
Epidemiology
WHO, 25% out of 6.840.507.000 babies experience
napkin eczema
Most incidence range at age 6-12 months
In Indonesia, napkin eczema affects 1/3 of babies
A study by Yuni Hermanto found that among 10
babies using diapers, 5 of them would develop diaper
rash.
Etiopathophysiology
Diaper rash develops as a
result of multiple
interactions, among
which the most
important is prolonged
contact of the skin with
urine and feces
Prolonged wetness in the diaper area leads to
maceration of the stratum corneum -> makes the
stratum corneum more susceptible to mechanical
friction, chemical and enzyme irritants, microbial
infections
Exposure of the skin to urine + feces -> increase
pH in diaper area to more alkaline values -> leads
to increased activity of fecal proteases, lipases, and
ureases, all of which are highly irritating to the
skin
There are also significant differences between the
infant and adult epidermis: smaller keratinocytes,
denser microrelief structures, thinner stratum
corneum, greater cell proliferation, and a different
organization of collagen fibers in the dermis
Other factor that increse susceptibility; infrequent
diaper change, use of broad spectrum antibiotics in
infants, poor skin care in the diaper area, the use of
liquid soaps for skin cleansing, and the use of talcum
powder
Clinical Manifestation
1. Discomfort->irritable
2. Skin lessions
Macula eritem
Erosion
Diagnosis
•History Taking

•Complaints that often arise is in the form of

redness or rash on the buttocks and later and
the area around the genitals after a long diaper
use.

•Ask:
•The type of diaper used
•The length of use of diapers in one day
•Family history of atopy
•History of drug use.
Diagnosis
•Physical Examination:

•Areas that are often affected are in areas

that come in contact with diapers,
namely the buttocks, genitals, lower
abdomen, pubic area, and upper thighs.

•The deeper parts of the inguinal fold are

rarely affected.

•In the mildest form there is only

erythema, but with increasing severity,
papules, vesicles, small erosions, and
larger sores can occur.
 Diagnosis
•Supporting Examination:

•Complete blood: If systemic symptoms such as fever appear

and to see a secondary infection. If there is anemia and
hepatosplenomegaly is suspected to have langerhans cell
histiosis.

•Serology Test: For patients suspected of having congenital

syphilis.

•KOH: If you suspect diaper rash is caused by fungus.

 Differential Diagnosis
A. Irritant Contact Dermatitis
Strong -> acute: painful, hot, burning, erythema, edema, bull, necrosis,

firm
Acute slow: erythema, evening vesicles / necrosis (dermatitis venenata)

Cumulative: dry, erythema, squama, thick, lichenification, fissure,

itching


Exposure to irritants, for example:

Solvent

Detergent

Lubricant

Alkaline acid

Sawdust
 Differential Diagnosis
. Allergy Contact Dermatitis
Itchy
Acute: erythema, firm border, edema, papulo vesicles,
vesicles, bulls, rupture into erosion & exudates.
Chronic: dry, squamous, papule, lichenification,
fissure, firm boundary.
Most often: hands
 Differential Diagnosis
C. Infantil Psoriasis
Infantile psoriasis shows firmly demarcated red
plaque with the involvement of a typical fold area
 Differential Diagnosis
D. Candidia Infection
Erythematous and scaly plaques that clinically involve
folds with satellite papules and pustules
Management
Non Farmacology
1. Cleanliness --> Good hygiene is needed to prevent
damage to skin defenses. The ideal formulation of
cleaning fluid or emollient must be a neutral or acidic
pH
2. topical emollients --> prevent irritation.
3. Change diapers frequently —> don’t let the baby use
wet diappers to prevent the irritation.
4. Zinc oxide can be used
Farmacology
Topical
1. Mild potential topical corticosteroids --> Group VII-VI
such as Hydrocortison, dexamethason, etc.
2. Antifungal Topical --> such as nistatin, clotrimazole,
miconazole, ketoconazole, atau ciclopirox.

Sistemic
Secondary infection —> amoxiclap, klindamicyn.
THANK YOU