Dermatitis diaper

Diaper dermatitis, more commonly known as diaper rash, is a form of irritant contact dermatitis that affects the buttocks, upper thighs, lower abdomen, and genitalia of an estimated 7% to 35% of all infants.34,35 Onset of occurrence is usually between 3 weeks and 2 years of age, with the most cases reported between 9 and 12 months of age.36 More than 12 million adults who use diapers for incontinence also have an increased risk of developing diaper dermatitis.35... 

Because of the increased permeability of their skin, infants are at risk for excessive absorption and toxicity from the use of topical steroids. Although these agents are effective in decreasing inflammation and relieving pruritus, steroid use in infants for the treatment of diaper dermatitis should be limited to only the low-potency preparations.38... 

FIGURE 62-6. Candidiasis diaper dermatitis. Confluent erosions, marginal scaling, and "satellite pustules" in the area covered by a diaper in an infant. (From Wolff K, Johnson RA. Cutaneous fungal infections. Fitzpatrick s Color Atlas Synopsis of Clinical Dermatology. 5th ed. New York McGraw-Hill,... 

If conventional treatment fails, unresolved diaper rash can also lead to secondary bacterial infections. Staphylococcus aureus and streptococci are the most likely pathogens responsible for these infections and require treatment with systemic antibiotics.3 37 While topical protectants may be used as an adjunct in treatment, suspected bacterial infections should always be referred to a physician for accurate diagnosis and the selection of an appropriate antibacterial regimen.34 Figure 62-7 shows a useful algorithm for the effective treatment of diaper dermatitis. 

Padron VA. Diaper dermatitis and prickly heat. In Berardi RR, McDermott JH, Newton GD, et al, eds. Handbook of... 

The word dermatitis denotes an inflammatory erythematous rash. The disorders discussed in this chapter include contact dermatitis, seborrheic dermatitis, diaper dermatitis, and atopic dermatitis. Drug-induced skin disorders have been associated with most commonly used medications and may present as maculopapular eruptions, fixed-drug eruptions, and photosensitivity reactions. 

Diaper dermatitis (diaper rash) is an acute, inflammatory dermatitis of the buttocks, genitalia, and perineal region. The reaction is a type of contact dermatitis, as it results from direct fecal and moisture contact with the skin in an occlusive environment. 

Seborrheic dermatitis typically occurs around the areas of skin rich in sebaceous follicles (e.g., the face, ears, scalp, and upper trunk). In infants with involvement ofthe scalp, the condition is commonly referred to as cradle cap. Diaper dermatitis results in erythematous patches, skin erosions, vesicles, and ulcerations. Although commonly seen in infants, it can occur in adults who wear diapers for incontinence. 

Some topical anti-infectives contain corticosteroids in addition to antibiotics. There is no convincing evidence that topical corticosteroids inhibit the antibacterial effect of antibiotics when the two are incorporated in the same preparation. In the treatment of secondarily infected dermatoses, which are usually colonized with streptococci, staphylococci, or both, combination therapy may prove superior to corticosteroid therapy alone. Antibiotic-corticosteroid combinations may be useful in treating diaper dermatitis, otitis externa, and impetiginized eczema. 

People with other acute, chronic, or exfoliative skin conditions (such as bums, impetigo, varicella zoster, herpes, severe acne, severe diaper dermatitis with extensive areas of denuded skin, psoriasis). 

Many factors contribute to the initiation of diaper rash, including excess moisture, rubbing and friction, skin contact with urine and feces, and/or allergic reaction to the diaper material or to creams, powder, or wipes. While true diaper rash (irritant diaper dermatitis) is most common in babies between the ages of four and fifteen months, incontinent adults... 

Treatment of diaper dermatitis includes frequent diaper changes and keeping the area dry. Lukewarm water and mild soap can be used to cleanse the area thoroughly, which should then be allowed to dry. Occlusive agents—such as zinc oxide, titanium dioxide, petrolatum, or any combination of these—should be generously applied to the area before the diaper is applied. 

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