Note the sparing of the folds.

DIAPER DERMATITIS

Diaper dermatitis (DD) is an irritant dermatitis from the stool and urine and is worsened by maceration and friction.

• DD occurs most commonly in infants younger than 12 months of age.
• Exclusive breastfeeding plays a role in the prevention of DD, so mothers should be encouraged to breastfeed their babies.
• Secondary infection is common, particularly with Candida, Staphylococcus and Streptococcus.
  
• Within the differential diagnosis is infection with tinea, candida, allergic contact dermatitis and Langerhans cell histiocytosis..
  
• It is often pragmatic to try a topical antifungal first in the setting of a diaper rash and it not helful, then add/switch to a topical steroid.

Clinical

The diaper area is red and edematous although the flexures are usually spared (in contrast to seborrheic dermatitis in diaper dermatitis. The rash may sharply end at the edge of the diaper. A bout of diarrhea may bring on or exacerbate the condition. Satellite red follicular papules and pustules indicated Candida infection.

Treatment

• Hydrocortisone 2.5% ointment mixed with ketaconazole 2% cream BID (or can apply separately)
• See Handout

Frequent diaper changes using superabsorbent disposable (instead of cloth) diapers to keep the skin as dry as possible are of paramount importance. Checking the diaper hourly (and changing if wet or soiled) is a reasonable frequency. Hydrocortisone cream 1% and an antifungal cream mixed together and applied with each diaper change is helpful. The antifungal medication combats candida, which in practice is a frequent secondary condition. One may alternatively apply a barrier cream (e.g., zinc oxide ointment or petrolatum) after each diaper change and apply the combination of HC and an antifungal BID.

Cleanse with plain water and a washcloth or fragrance-free diaper wipes. Wet wipes have been shown to have the potential for causing an allergic contact dermatitis through the preservative methylisothiazolinone. This allergy may cause either a perioral eruption or a diaper rash.

RegionalDerm

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