Irritant Diaper Dermatitis

Aka: Irritant Diaper Dermatitis, Diaper Rash, Diaper Dermatitis

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II. Etiology

  1. Reaction to friction and maceration
  2. Prolonged contact with urine and feces

III. Symptoms

  1. Infant very uncomfortable with increased inflammation

IV. Signs

  1. Erythematous, scaly dermatitis
  2. Papulovesicular or Bullous lesions
  3. Fissures and erosions
  4. Patchy or confluent
  5. Sparing of genitocrural folds

V. Differential Diagnosis

  1. Candida Diaper Dermatitis (satellite lesions present)
  2. Perianal Streptococcal Dermatitis
  3. Impetigo
  4. Contact Dermatitis
    1. Found on convex surfaces (contrast with candida which is found in skin folds)
    2. Apply thick layer of barrier cream (e.g. Zinc Oxide cream)
  5. Pediatric Seborrheic Dermatitis
    1. Typically associated with Cradle Cap
  6. Rare, refractory cases
    1. Hand-Schuller-Christian Syndrome (Histiocytosis X)
    2. Zinc Deficiency
      1. Acrodermatitis Enteropathica related that manifests after stopping Breast Feeding in infants

VI. Complications

  1. Bacteria or yeast superinfection
  2. Irritant dermatitis superinfected by yeast in 3-5 days

VII. Management

  1. Frequent diaper changes
  2. If possible, let child go without bottoms (keep area dry)
  3. Use disposable diapers
  4. Thorough washing of genitalia with diaper change
    1. Alcohol-free, fragrance-free wipes or
    2. Mild Soap and warm water
  5. Apply occlusive topical agent after washing
    1. Zinc Oxide
    2. Petroleum jelly
    3. Aquaphor
  6. Additional topicals
    1. Topical Corticosteroid (with or without Zinc Oxide)
      1. Hydrocortisone Cream 0.5-1% (or other Level 6-7 Topical Corticosteroids such as Desowen)
      2. Avoid more potent Corticosteroids (Level 5 and less, including Triamcinolone)
      3. Indicated for significant inflammation and use until healing completed
    2. Antifungals
      1. Indicated if superinfection with Candida Diaper Dermatitis suspected
      2. Typically occurs after 4-5 days of Irritant Diaper Dermatitis
      3. Preparations include Clotrimazole, Micoazole and Nystatin
  7. Avoid harmful or unnecessary agents
    1. Avoid systemic Antibiotics (not indicated)
    2. Avoid occlusive plastic pants (promotes maceration)
    3. Avoid expensive topicals (e.g. Vusion: 0.25% Miconazole, Zinc Oxide, petrolatum)

VIII. Prevention (especially during times of Diarrhea)

  1. Wash anal area after each stool
  2. Apply vaseline
    1. Apply after each diaper
    2. Apply especially at night and at naptime
  3. Change diaper immediately after each stool

IX. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. (2018) Presc Lett 25(10): 57 [PubMed]

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Related Studies

Ontology: Diaper Rash (C0011974)

Definition (NCI) An inflammatory skin condition in the diaper area that may be caused by irritation of infection.(NICHD)
Definition (MSH) A type of irritant dermatitis localized to the area in contact with a diaper and occurring most often as a reaction to prolonged contact with urine, feces, or retained soap or detergent.
Concepts Disease or Syndrome (T047)
MSH D003963
ICD9 691.0
ICD10 L22
SnomedCT 238582000, 91487003
English Diaper Rash, Diaper Rashes, Rashes, Diaper, Rash, Diaper, Diaper [napkin] dermatitis, diaper rash, diaper rash (diagnosis), Dermatitis diaper, Nappy rash NOS, Diaper Rash [Disease/Finding], diaper rashes, Dermatitis;napkin, Rash;nappy, diaper dermatitis, Jacquet's dermatitis (disorder), Nappy Rash, Diaper Dermatitis, Diaper dermatitis, Diaper rash, Ammonia dermatitis, Diaper erythema, Jacquet's dermatitis, Jacquet's erythema, Diaper rash (disorder), Jacquet; dermatitis, Jacquet, dermatitis; Jacquet, diaper; erythema, eczema; napkin, eruption; napkin, erythema; diaper, napkin; dermatitis, napkin; eczema, napkin; eruption, napkin; rash, rash; napkin, Napkin rash, Ammoniacal napkin dermatitis, Irritant napkin dermatitis, Nappy rash, Nappy rash - irritant, Diaper or napkin rash, Diaper or napkin dermatitis, Diaper or napkin erythema, napkin dermatitis, nappy rash
Italian Dermatite da pannolino, Eritema da pannolino, Eritema causato da pannolino, Eritema da pannolino NAS, Rash da pannolino
Dutch luieruitslag, luierrash, luierrash NAO, Jacquet; dermatitis, dermatitis; Jacquet, eczeem; luier, eruptie; luier, erytheem; luier, luier; dermatitis, luier; eczeem, luier; eruptie, luier; erytheem, luier; uitslag, uitslag; luier, luierdermatitis, Dermatitis, luier-, Luierdermatitis, Luiereczeem, Luieruitslag
French Erythème fessier du nourrisson SAI, Erythème fessier du nourrisson, Erythème fessier du nouveau-né, Dermatite en nid d'abeille, Érythème fessier, Érythème fessier du nourrisson, Dermatite par les couches, Érythème papulo-érosif
German Windel- oder Verbandausschlag, Windelausschlag NNB, Windelausschlag, Windeldermatitis
Portuguese Erupção cutânea das fraldas, Erupção cutânea na região das fraldas, Erupção cutânea na região das fraldas NE, Assaduras Infantis, Dermatite causada pela fralda, Dermatite das Fraldas
Spanish Exantema del pañal NEOM, Eritema del pañal, Exantema del pañal, Panalitis, dermatitis amoniacal, dermatitis de Jacquet, dermatitis del pañal (trastorno), dermatitis del pañal, eritema de Jacquet, eritema del pañal, salpullido del pañal, sarpullido del pañal, Dermatitis del pañal, Dermatitis del Pañal
Japanese おむつ皮膚炎ＮＯＳ, ｵﾑﾂﾋﾌｴﾝ, ｵﾑﾂﾋﾌｴﾝNOS, おむつかぶれ, おむつ皮膚炎, おむつ負け
Swedish Blöjutslag
Czech dermatitida plenková, Plenková dermatitida, Plenková vyrážka, Plenková vyrážka NOS, Vyrážka z plen nebo dámské vložky
Finnish Vaippaihottuma
Russian "PELENOCHNYI" DERMATIT, OPRELOST' U MLADENTSA, ОПРЕЛОСТЬ У МЛАДЕНЦА, "ПЕЛЕНОЧНЫЙ" ДЕРМАТИТ
Korean 기저귀 [냅킨] 피부염
Polish Zapalenie skóry pieluszkowe
Hungarian Pelenka dermatitis, Pelenkakiütés, Pelenka exanthema, Pelenka-kiütés, Pelenkakiütés k.m.n.
Norwegian Bleieeksem, Bleiedermatitt, Bleieutslett
Derived from the NIH UMLS (Unified Medical Language System)

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