- •
Diaper dermatitis is an irritant contact dermatitis that is typically self-limited.
- •
An impaired barrier function of the skin develops because of the presence of moisture, friction, and irritants from the contents of urine and feces.
- •
Attempts to minimize irritants with the use of modern disposable diapers and barrier emollients decrease the incidence of diaper dermatitis.
Diagnosis and Management of Diaper Dermatitis
Section snippets
Key points
History
A thorough history including the infant’s bathing, cleansing, and diapering routine should be obtained. Encourage the patient’s family to bring in all of the products that have been used in case specific ingredients need to be checked. Factors to consider when evaluating for diaper dermatitis are listed in Box 1.
Physical Examination
Common areas involved in diaper dermatitis include the convex surfaces in contact with the diaper, such as the buttocks, lower abdomen, medial thighs, labia majora, and scrotum. Due to
Differential diagnosis
There is a broad differential for eruptions that may develop in the diaper area (Table 1).
Laboratory Studies
The diagnosis of irritant diaper dermatitis is based on clinical findings. If there are erosions, erythematous papules, or pustules present, a workup for an infection should be considered. Depending on the index of suspicion, a Gram-stain and bacterial culture, KOH preparation, and fungal culture or a Tzanck smear, direct fluorescent antibody or HSV PCR and viral culture may be warranted. A skin biopsy should be considered when an eruption is resistant to treatment, is atypical, or if
Therapeutic recommendations
Management of irritant diaper dermatitis involves gentle cleansing, choice of diapers, and minimizing exposure to potential irritants, such as moisture, friction, urine, and feces. Once inflammation is present, measures should be taken to calm the inflammation and if present treat any secondary infections. There are a lack of controlled trial data to support any particular treatment regimen.26, 27 Parent education and support are essential when treating this typically self-limited condition (
Complications
Potential complications of diaper dermatitis when the skin barrier is compromised include pain, and Candidal or bacterial (Staphylococcal or Streptococcal) superinfections. These conditions are addressed above in the differential diagnosis and management section.
Summary
Diaper dermatitis is a common condition with most cases being self-limited. Prevention and treatment should be directed against moisture, friction, and irritation. With parent education and support, most mild to moderate cases of diaper dermatitis can be controlled with a gentle cleansing routine, frequent diaper changes, air exposure, and thick barrier preparations that contain zinc oxide and/or petrolatum. When an infant fails to respond to these measures, one must consider if the family is
References (45)
- et al.
Influence of type of feeding on pH of stool, pH of skin and the incidence of perianal dermatitis in the newborn infant
J Pediatr
(1955) - et al.
Prescription of high-potency corticosteroid agents and clotrimazole-betamethasone dipropionate by pediatricians
Clin Ther
(1999) A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis
Curr Med Res Opin
(2004)- et al.
Association of skin wetness and pH with diaper dermatitis
Pediatr Dermatol
(1994) - et al.
The effects of wearing diapers on skin
Pediatr Dermatol
(1986) - et al.
Documentation of impaired epidermal barrier in mild and moderate diaper dermatitis in vivo using noninvasive methods
Pediatr Dermatol
(2011) - et al.
Etiologic factors in diaper dermatitis: the role of urine
Pediatr Dermatol
(1986) - et al.
Faecal enzymes: in vivo human skin irritation
Contact Dermatitis
(1994) - et al.
Etiologic factors in diaper dermatitis: the role of feces
Pediatr Dermatol
(1986) - et al.
Diaper dermatitis: frequency and severity among a general infant population
Pediatr Dermatol
(1986)
Diaper dermatitis – frequency and contributory factors in hospital attending children
Pediatr Dermatol
(2007)
Skin flora of infants with napkin rash
Br J Dermatol
(1971)
Microbial flora of infant’s skin. Comparison of types of microorganisms between normal skin and diaper dermatitis
Arch Dermatol
(1971)
The role of microorganisms in diaper dermatitis
Arch Dermatol
(1978)
Characterization of diaper dermatitis in the Unites States
Arch Pediatr Adolesc Med
(2000)
Effects of breathable disposable diapers: reduced prevalence of Candida and common diaper dermatitis
Pediatr Dermatol
(2001)
Clinical correlates with diaper dermatitis
Pediatrician
(1987)
“Lucky Luke” contact dermatitis due to rubber components of diapers
Contact Dermatitis
(1998)
Diaper dye dermatitis
Pediatrics
(2005)
The role of allergic contact dermatitis in diaper dermatitis
Pediatr Dermatol
(2009)
Granuloma gluteale infantum with atrophic scars: clinical and histological observations in 11 cases
Clin Exp Dermatol
(1981)
Microbiological aspects of diaper dermatitis
Dermatology
(2003)
Cited by (0)
Funding Sources: None.
Conflict of Interest: Onset Dermatologics, Advisory Board.
Copyright © 2014 Elsevier Inc. All rights reserved.