Diagnosis
DDx & Etiology.
Risk Factors:
-Age 8-10 months old;
-Poor hygiene (leaving stool/urine diapers on too long);
-Diarrhea (e.g. from infection or when teething);
-Introducing new solid foods into diet;
-Taking antibiotics (encourages growth of yeast)
Complications: Superinfection.
Treatment
Treatment per etiology.
Contact irritant dermatitis
-Frequent diaper checks (q2-3h intervals) to minimize exposure to irritants.
-Change diaper as soon as possible after each void or stool.
-Gently wash bottom with warm water instead of wiping to avoid irritation.
-Avoid excessive washing; avoid use of potentially irritating soaps and cleansers. Only use gentle diaper wipes that don’t contain alcohol, fragrance, irritants, or sensitizers–and only when the skin is intact.
-Expose bottom to air as much as feasible.
-Apply Desitin cream (Zinc Oxide) after each diaper change to protect diaper area.
-Determine and remove/reduce exposure to irritants.
-Avoid products that combine barrier ointments with pharmacotherapy (antibiotics, antifungal, and steroids to prevent s/e of over use of topical steroids
Diaper candidiasis
-Skin care as with contact dermatitis
-Nystatin cream, fluconazole (if systemic)
Background
Diaper rashes are usually caused by irritation & friction, infection (bactrial and fungi), and allergic reaction.
–Irritation & friction: A baby’s skin may get irritated when a diaper is left on for too long or poop or the diaber itself rubs agains the skin repeatedly. Irritants such as feces, urine, or cleaning agents irritate the skin. Urine and bowel movements are acidic and can irriate the skin. This rash occurs in the area where the diaper has rubbed and is normally not seen in the folds of the skin.
-Infection – Candidal rash: Candidal rash is bright, beefy red in appearance and is very common after the use of antibiotics. Urine changes the skin’s pH levels, and enables bacteria and fungi grow easily.The diaper prevents air circulation, creating a warm, moist environment where bacteria and fungi can thrive, causing a rash.
-Allergic reaction: Babies with sensitive skin may develop rashes. Certain types of laundry detergent, soaps, diapers (or dyes from diapers), lotion, elastic in plastic pants, or baby wipes can affect sensitive skin, causing a rash.
-Seborrhea: This is an oily, yellow-colored rash that may also be seen in other areas of the body, such as the face, head, and neck.
Reference and Resources
Clinical Pediatrics. Differential Diagnosis of Diaper Dermatitis. Vol 56, Issue 5_suppl, pp. 16S – 22S. April 18, 2017. Author: Bernard Cohen, MD