Diaper dermatitis: Difference between revisions

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==Background==
==Background==
*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>
{{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
*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" />
*Breast-feeding associated with lower rates of severe diaper dermatitis<ref name="Shin" />


[[File:Contact diaper dermatitis.jpg|thumb|Contact [[diaper dermatitis]]]]
{{Dermatitis types}}


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


==Differential Diagnosis==
==Differential Diagnosis==
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*Hygiene
*Hygiene
**Air drying
**Air drying
**Cleansing regimen (gentle cleaning with water or soap)
**Cleansing regimen (gentle cleaning with water; avoid soap)
**Superabsorbent gel diapers
**Superabsorbent gel diapers
**Frequent changing
**Frequent changing
**Barrier creams (zinc oxide)
**Barrier creams (zinc oxide)
**Powders (but caution due to risk of aspiration)
**Powders (but caution due to risk of aspiration)
*Topical corticosteroids (if resistant to hygiene measures)<ref name="Shin" />
*[[Topical corticosteroids]] (if resistant to hygiene measures)<ref name="Shin" />
**[[Hydrocortisone]] cream BID (for no longer than 2 weeks)
**[[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)
**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" />
*[[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)
**[[Nystatin]] cream 100,000 U/gram TID x10-14d (If using zinc oxide cream, apply after nystatin)
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***Econazole 1% cream to affected area BID, continue for 3 days after resolution
***Econazole 1% cream to affected area BID, continue for 3 days after resolution
*Antibacterial therapy (if suspect bacterial infection)<ref name="Shin" />
*Antibacterial therapy (if suspect bacterial infection)<ref name="Shin" />
**Mupirocin, [[bacitracin]], polysporin, retapamulin
**[[Mupirocin]], [[bacitracin]], polysporin, retapamulin


==Disposition==
==Disposition==

Latest revision as of 16:22, 11 December 2024

Background

Normal dermal anatomy.
  • Irritant contact dermatitis - the most common skin disorder in infants[1]
  • Caused by presence of urine, feces, moisture, friction → breakdown of skin barrier
  • Breast-feeding associated with lower rates of severe diaper dermatitis[1]

Dermatitis Types

Clinical Features

Contact diaper dermatitis
  • Erythematous, macular and/or papular rash with well demarcated borders
  • More severe disease will also have skin maceration and erosions
  • Candidal rash will include scaling around margins
    • Classic finding is "satellite lesions" in other locations
    • Also examine for oral thrush

Differential Diagnosis

Neonatal Rashes

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)[1]
    • Hydrocortisone 2.5% ointment BID over 2 weeks for mild cases
    • Triamcinolone 0.025% ointment BID over 2 weeks for moderate to severe cases [2]
    • Absorption increased due to moisture and diaper (Cushing syndrome has been reported with overuse)
  • Topical sucralfate may also be used[3]
  • Antifungal cream (if suspect candida dermatitis)[1]
    • 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)[1]

Disposition

  • Discharge

See Also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr;61(2):367-82.
  2. ↑ https://www.chop.edu/clinical-pathway/atopic-dermatitis-topical-steroid-treatment-recommendations
  3. ↑ 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
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