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> | ||
*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" /> | |||
[[File:Contact diaper dermatitis.jpg|thumb|Contact [[diaper dermatitis]]]] | [[File:Contact diaper dermatitis.jpg|thumb|Contact [[diaper dermatitis]]]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Erythematous, macular or papular | *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 | *Candidal rash will include scaling around margins | ||
**Classic finding is "satellite lesions" | **Classic finding is "satellite lesions" in other locations | ||
**Also examine for oral thrush | **Also examine for oral thrush | ||
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==Diagnosis== | ==Diagnosis== | ||
*Clinical diagnosis, based on history and physical examination | *Clinical diagnosis, based on history and physical examination | ||
*If erosions or pustules → consider infectious work-up. | |||
==Management== | ==Management== | ||
* | *Hygiene | ||
* | **Air drying | ||
**Nystatin cream 100,000 U/gram TID x10-14d | **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 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)<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. | |||
==Disposition== | ==Disposition== | ||
Revision as of 09:59, 17 August 2015
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
Diagnosis
- Clinical diagnosis, based on history and physical examination
- If erosions or pustules → consider infectious work-up.
Management
- Hygiene
- Air drying
- 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.
Disposition
- Discharge