View source for Diaper dermatitis

==Background==
{{Skin anatomy background images}}
*Irritant [[contact dermatitis]] - the most common skin disorder in infants<ref name="Shin">Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr;61(2):367-82.</ref>
*Caused by presence of urine, feces, moisture, friction → breakdown of skin barrier
*Breast-feeding associated with lower rates of severe diaper dermatitis<ref name="Shin" />

{{Dermatitis types}}

==Clinical Features==
[[File:Contact diaper dermatitis.jpg|thumb|Contact [[diaper dermatitis]]]]
*Erythematous, macular and/or papular [[rash]] with well demarcated borders
*More severe disease will also have skin maceration and erosions
*[[candida dermatitis|Candidal rash]] will include scaling around margins
**Classic finding is "satellite lesions" in other locations
**Also examine for [[oral thrush]]

==Differential Diagnosis==
{{Neonatal rashes DDX}}

==Evaluation==
*Clinical diagnosis, based on history and physical examination
*If erosions or pustules → consider infectious work-up

==Management==
*Hygiene
**Air drying
**Cleansing regimen (gentle cleaning with water; avoid soap)
**Superabsorbent gel diapers
**Frequent changing
**Barrier creams (zinc oxide)
**Powders (but caution due to risk of aspiration)
*[[Topical corticosteroids]] (if resistant to hygiene measures)<ref name="Shin" />
**[[Hydrocortisone]] 2.5% ointment BID over 2 weeks for mild cases
**[[Triamcinolone]] 0.025% ointment BID over 2 weeks for moderate to severe cases <ref name="chop"> https://www.chop.edu/clinical-pathway/atopic-dermatitis-topical-steroid-treatment-recommendations</ref>
**Absorption increased due to moisture and diaper (Cushing syndrome has been reported with overuse)
*Topical [[sucralfate]] may also be used<ref>Markham T, Kennedy F, Collins P. Topical sucralfate for erosive irritant diaper dermatitis. Arch Dermatol. 2000;136(10):1199-1200. doi:10.1001/archderm.136.10.1199</ref>
*[[Antifungal]] cream (if suspect candida dermatitis)<ref name="Shin" />
**[[Nystatin]] cream 100,000 U/gram TID x10-14d (If using zinc oxide cream, apply after nystatin)
**Other options include: [[clotrimazole]], ketoconazole, [[miconazole]], oxiconazole, econazole, sertaconazole
***[[Miconazole]] 0.25% cream to affected area with each diaper change x 7 days
***Econazole 1% cream to affected area BID, continue for 3 days after resolution
*Antibacterial therapy (if suspect bacterial infection)<ref name="Shin" />
**[[Mupirocin]], [[bacitracin]], polysporin, retapamulin

==Disposition==
*Discharge

==See Also==
*[[Neonatal rashes]]

==References==
<References/>

[[Category:Dermatology]]
[[Category:Pediatrics]]