Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 18/03/2015
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Pamela Chayavichitsilp and Lawrence F. Eichenfield
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Diaper (napkin) dermatitis is a form of irritant contact dermatitis which presents as erythema and mild scaling on the convex surfaces of the inner upper thigh, lower abdomen, and buttock areas, classically sparing the inguinal folds where the skin is not in contact with irritants. It can present as early as 3 weeks of age or as late as 2 years. Many other dermatoses can affect the diaper area and may need to be excluded.
Diaper dermatitis is triggered by irritants present in the area covered by the diaper, which acts as an occlusive surface. Moisture from urine and feces increases the friction coefficient of the skin, causing frictional damage. Skin integrity is further compromised by the increased pH from urine and fecal enzymes and the physical erosive effects of these activated enzymes. The reduction in skin barrier function and increase in pH contribute to the increased susceptibility to infections with microorganisms such as Candida albicans, which further increases the severity of diaper dermatitis. Therefore, management should aim at preventing over-hydration and frictional damage in the diaper area.
Frequent diaper changes, particularly after defecation, reduce moisture and prevent the build-up of irritants. This is therefore one of the most important steps in the management of diaper dermatitis. Disposable diapers containing superabsorbent gelling materials and breathable backsheets are preferred to those without. Cloth diapers should be avoided, as they have been shown to be associated with an increased incidence of diaper dermatitis compared to disposable diapers.
The skin in the area may be cleaned with water alone or with mild soap. Baby wipes should not contain fragrance or alcohol. Rubbing of the area can cause damage to the skin and should be avoided.
A barrier cream may be applied at every diaper change. This can provide a barrier between the skin and irritants in order to reduce friction and contact with stool and urine.
A low-potency topical steroid such as hydrocortisone 1% ointment can be used in more severe cases of diaper dermatitis, but must be used sparingly to avoid skin atrophy and systemic absorption. High-potency steroids should be avoided in diaper dermatitis, including the use of compound formulations containing potent steroids and antimicrobial agents.
Topical antifungal preparations are recommended for use in proven or suspected cases of C. albicans infection.
Inquiry about recent antibiotic usage
In selected cases:
KOH preparation, fungal and bacterial cultures
Serum zinc and biotin levels
Skin biopsy
Patch testing
Honig PJ, Gribetz B, Leyden JJ, McGinley KJ, Burke LA. J Am Acad Dermatol 1988; 19: 275–9.
Skin cultures for C. albicans were done in 57 infants with otitis media before and after amoxicillin therapy in sites including the mouth, nose, rectum, perineum, inguinal folds, and buttocks. A twofold increase in C. albicans was detected after 10 days of antibiotic therapy. Infants who later developed diaper dermatitis had a significant increase in the number of C. albicans compared to those who did not.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
