Diaper dermatitis

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]

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

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]

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.