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> | *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" /> | ||
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==Clinical Features== | ==Clinical Features== | ||
*Erythematous, macular and/or papular rash with well demarcated borders | *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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**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]] cream BID (for no longer than 2 weeks) | ||
**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) | ||
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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== | ||
Revision as of 20:54, 27 September 2019
Background
- 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]
Contact diaper dermatitis
Clinical Features
- 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
- Acne
- Atopic dermatitis
- Candidiasis
- Contact dermatitis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Impetigo
- Mastitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Perianal streptococcal dermatitis
- Psoriasis
- Pustular melanosis
- Seborrheic dermatitis
- Sucking blisters
- Tinea capitis
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 or 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 cream BID (for no longer than 2 weeks)
- Absorption increased due to moisture and diaper (Cushing syndrome has been reported with overuse)
- 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]
- Mupirocin, bacitracin, polysporin, retapamulin
Disposition
- Discharge