Diaper Rash

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Basics

Description

Diaper dermatitis is a general term used to describe any inflammatory skin rash that develops in the perineal region. Also known as diaper or napkin rash, there are several causes of diaper dermatitis. Most often, diaper rash is caused by an acute irritant contact dermatitis, which is the focus of this chapter.

ALERT
  • Severe cases of diaper dermatitis may be complicated by bacterial or fungal infection, which may require treatment with topical or systemic antibiotics and/or antifungals.
  • If severe cases fail to respond to conventional therapies, consider other diagnoses such as Langerhans cell histiocytosis, acrodermatitis enteropathica, or seborrheic dermatitis.

Epidemiology

Incidence

  • The reported incidence varies worldwide due to differences in diaper use, toilet training, hygiene, and child-rearing practices.
  • Can develop in the 1st week of life but unlikely once the child is no longer in diapers

Prevalence

Estimated prevalence ranges from 7% to 35%.

Risk Factors

  • Diarrhea increases the risk of irritant diaper rash.
  • The presence of oral thrush or recent antibiotic use increases the risk of secondary Candida albicans infection.
  • Formula-fed infants may have higher risk of diaper dermatitis due to higher stool pH.

General Prevention

  • Frequent diaper changes and proper skin care help prevent diaper rash.
  • Diapers should be changed as often as every 2 hours or sooner if diaper is wet and/or soiled.
  • Superabsorbent diapers (disposable diapers containing gelling materials) keep moisture away from skin and may prevent diaper dermatitis compared to cloth diapers.
  • Some experts recommend soft cloths and water for cleansing due to preservatives in baby wipes. As manufacturers have decreased the number of additives, contact dermatitis due to wipes has become less common.
  • Petrolatum and/or zinc oxide provide effective barriers against potential perineal skin irritants and moisture. Several authors advise caregivers to refrain from rubbing barrier products off completely during diaper changes to prevent further skin damage.

Etiology

The pathophysiology is multifactorial, including moisture, friction, warmth, urine, and feces.

  • Friction: Rubbing of wet diapers against exposed skin can result in chafing, maceration, and irritation.
  • Moisture trapped against skin causes increased permeability and susceptibility to damage from friction.
  • Irritation: Urine raises the pH, which activates fecal enzymes resulting in skin damage.
  • As the skin barrier breaks down, microbes are more likely to cause a secondary infection.
    • Common causes of secondary infections include C. albicans, group A β-hemolytic Streptococcus, and Staphylococcus aureus.

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