DESCRIPTION

Diaper dermatitis is a general term used to describe any inflammatory skin rash that develops in the perineal region; also known as diaper 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.

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

EPIDEMIOLOGY

• The reported incidence varies worldwide due to differences in diaper use, toilet training, hygiene, and child-rearing practices, but most babies will have a diaper rash at least once during infancy. Approximately 25% of infants are diagnosed with a diaper rash by a physician.
• Can develop in the 1st week of life but unlikely once the child is no longer in diapers
• Reaches its peak between 9 and 12 months of age
• Estimated prevalence ranges from 7% to 35%.

ETIOLOGY

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

• Friction: Rubbing of wet diapers against exposed skin during routine wear as well as friction during cleansing 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 Candida albicans, group A β-hemolytic Streptococcus, and Staphylococcus aureus.

RISK FACTORS

• Diarrhea increases the risk of irritant diaper rash.
• Any process that contributes to skin breakdown (friction from aggressive wiping, prolonged exposure to urine or stool, allergic contact dermatitis associated with dyes, fragrances, preservatives, or other components of some wipes, creams, or diapers) can contribute to diaper dermatitis.
• The presence of oral thrush or recent antibiotic use increases the risk of secondary C. albicans infection.

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, allergic contact dermatitis due to wipes has become less common.
• Zinc oxide, petroleum, vitamins A and D, and other over-the-counter protectant creams provide effective barriers against potential perineal skin irritants and moisture. Appropriate use involves applying a thick barrier layer with each diaper change. Several authors advise caregivers to refrain from rubbing barrier products off completely during diaper changes to prevent further skin damage.