Transcript Diaper Dermatitis

Diaper Dermatitis
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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
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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
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Factors Involved in Development
• Combination of:
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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
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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
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Differential Diagnosis
• Inflammatory
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Contact Dermatitis
Allergic Dermatitis
Intertrigo
Seborrheic Dermatitis
Atopic Dermatitis
Psoriasis
Granuloma gluteale infantum
• Malignancy
– Langerhans’ cell histiocytosis
• Miscellaneous
– Miliaria
– Child Abuse
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• Infectious
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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
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You Guess the Diagnosis!
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Irritant Diaper Dermatitis
Spares skin
folds
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Candidiasis
In folds of
skin
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Satellite
lesions
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Bullous Impetigo
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Note erosions
of skin
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Streptococcal Intertrigo
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Management of IDD
• Nonmedical
– Frequent diaper changes
– Gentle cleansing
– Barrier protection
• Medical
– Anti-inflammatory  low potency steroids
– Anti-fungal  lotrimin, nystatin
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Commonly Used Barrier Creams
ACTIVE INGREDIENTS
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Vitamin A&D ointment
Aquaphor
Aveeno diaper cream
Balmex ointment
Boudreaux’s paste
Desitin
Triple Paste
Zinc Oxide ointment
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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
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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
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