eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Diaper Rash: Differential Diagnoses & Workup

Author: Rania Dib, MD, Pediatric Senior Specialist, Procare Riaya Hospital, Al Khobar, Saudia Arabia
Coauthor(s): A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Jul 8, 2009

Differential Diagnoses

Candidiasis
Psoriasis
Dermatitis, Atopic
Scabies
Dermatitis, Contact
Syphilis
HIV Infection and AIDS
Tinea
Impetigo
Tuberculosis
Pediatrics, Kawasaki Disease
Warts, Genital

Other Problems to Be Considered

Seborrheic dermatitis
Letterer-Siwe disease
Acrodermatitis enteropathica
Chronic bullous dermatitis of childhood
Overtreatment dermatitis
Perianal dermatitis
Steroid induced dermatitis ("topica")
Bullous pemphigoid
Pemphigoid
Incontinentia pigmenti
Molluscum contagiosum
Hand-foot-mouth disease
Kaposi sarcoma

Workup

Laboratory Studies

  • The primary forms of diaper rash generally can be diagnosed clinically. Laboratory studies have few indications and limited utility.
  • A complete blood count may be helpful, especially if a fever is present and a secondary bacterial infection is suspected.
  • The finding of anemia in association with hepatosplenomegaly and the appropriate rash may suggest a diagnosis of Langerhans cell histiocytosis or congenital syphilis.
    • When suspecting congenital syphilis, relevant serology should be sent.
    • Dark field microscopic examination for spirochetes from any bullous lesion scrapings can be performed.
  • Serum zinc level of less than 50 mcg/dL can confirm acrodermatitis enteropathica.
  • Gram stain or culture of the characteristic bullae of impetigo for S aureus can confirm this diagnosis.
  • Routine cultures demonstrate polymicrobial infections (eg, streptococci, Enterobacteriaceae, and anaerobes) in nearly one half of cases.

Other Tests

  • Potassium hydroxide (KOH) scrapings from a fresh papular or pustular lesion may demonstrate pseudohyphae in suspected cases of candidiasis. However, these may be absent in long-standing cases.
  • Finding mites, ova, or feces on a mineral oil preparation of a burrow scraping can confirm the diagnosis of scabies.

Procedures

  • Skin biopsy can be performed to help differentiate granuloma gluteal infantum from granulomatous and neoplastic processes.
    • Histopathology, granuloma gluteal presents as nonspecific dermal inflammatory infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, occasional giant cells, and eosinophils, sometimes with an increase in the number of capillaries.
    • Examination of granuloma gluteal using an electron microscope reveals 3 types of giant cells: in the first type, the cells have widely enlarged endoplasmic reticulum; in the second type, they phagocytize erythrocytes; and in the third type, they have vesicles and granules and are similar to histiocytes. The name granuloma gluteal infantum is a misnomer since no granulomas are found in these lesions.
    • Skin biopsy also is used to confirm the diagnosis of Langerhans cell histiocytosis.

More on Pediatrics, Diaper Rash

Overview: Pediatrics, Diaper Rash
Differential Diagnoses & Workup: Pediatrics, Diaper Rash
Treatment & Medication: Pediatrics, Diaper Rash
Follow-up: Pediatrics, Diaper Rash
Multimedia: Pediatrics, Diaper Rash
References
[ CLOSE WINDOW ]

References

  1. Davis JA, Leyden JJ, Grove GL, Raynor WJ. Comparison of disposable diapers with fluff absorbent and fluff plus absorbent polymers: effects on skin hydration, skin pH, and diaper dermatitis. Pediatr Dermatol. Jun 1989;6(2):102-8. [Medline].

  2. Prasad HR, Srivastava P, Verma KK. Diapers and skin care: merits and demerits. Indian J Pediatr. Oct 2004;71(10):907-8. [Medline].

  3. Prasad HR, Srivastava P, Verma KK. Diaper dermatitis--an overview. Indian J Pediatr. Aug 2003;70(8):635-7. [Medline].

  4. Wilson PA, Dallas MJ. Diaper performance: maintenance of healthy skin. Pediatr Dermatol. Sep 1990;7(3):179-84. [Medline].

  5. Adam R. Skin care of the diaper area. Pediatr Dermatol. Jul-Aug 2008;25(4):427-33. [Medline].

  6. Korting HC, Braun-Falco O. The effect of detergents on skin pH and its consequences. Clin Dermatol. Jan-Feb 1996;14(1):23-7. [Medline].

  7. Walsh SS, Robson WJ. Granuloma gluteale infantum: an unusual complication of napkin dermatitis. Arch Emerg Med. Jun 1988;5(2):113-5. [Medline].

  8. Alberta L, Sweeney SM, Wiss K. Diaper dye dermatitis. Pediatrics. Sep 2005;116(3):e450-2. [Medline].

  9. Longhi F, Carlucci G, Bellucci R, di Girolamo R, Palumbo G, Amerio P. Diaper dermatitis: a study of contributing factors. Contact Dermatitis. Apr 1992;26(4):248-52. [Medline].

  10. Davies MW, Dore AJ, Perissinotto KL. Topical vitamin A, or its derivatives, for treating and preventing napkin dermatitis in infants. Cochrane Database Syst Rev. Oct 19 2005;CD004300. [Medline].

  11. Ehretsmann C, Schaefer P, Adam R. Cutaneous tolerance of baby wipes by infants with atopic dermatitis, and comparison of the mildness of baby wipe and water in infant skin. J Eur Acad Dermatol Venereol. Sep 2001;15 Suppl 1:16-21. [Medline].

  12. Gallup E, Plott T. A multicenter, open-label study to assess the safety and efficacy of ciclopirox topical suspension 0.77% in the treatment of diaper dermatitis due to Candida albicans. J Drugs Dermatol. Jan-Feb 2005;4(1):29-34. [Medline].

  13. Borkowski S. Diaper rash care and management. Pediatr Nurs. Nov-Dec 2004;30(6):467-70. [Medline].

  14. Adalat S, Wall D, Goodyear H. Diaper dermatitis-frequency and contributory factors in hospital attending children. Pediatr Dermatol. Sep-Oct 2007;24(5):483-8. [Medline].

  15. Atherton D. Maintaining healthy skin in infancy using prevention of irritant napkin dermatitis as a model. Community Pract. Jul 2005;78(7):255-7. [Medline].

  16. Atherton D, Mills K. What can be done to keep babies' skin healthy?. RCM Midwives. Jul 2004;7(7):288-90. [Medline].

  17. Atherton DJ. A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis. Curr Med Res Opin. May 2004;20(5):645-9. [Medline].

  18. Berg RW. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol. 1988;3:75-98. [Medline].

  19. Berg RW, Buckingham KW, Stewart RL. Etiologic factors in diaper dermatitis: the role of urine. Pediatr Dermatol. Feb 1986;3(2):102-6. [Medline].

  20. Brook I. Microbiology of secondarily infected diaper dermatitis. Int J Dermatol. Oct 1992;31(10):700-2. [Medline].

  21. Buckingham KW, Berg RW. Etiologic factors in diaper dermatitis: the role of feces. Pediatr Dermatol. Feb 1986;3(2):107-12. [Medline].

  22. Herbert J. The prevention and treatment of nappy rash. Some fresh insights into an old problem. Prof Care Mother Child. 1997;7(3):67-70. [Medline].

  23. Honda M. Differential diagnosis of unusual skin diseases in infants. Pediatrician. 1987;14 Suppl 1:15-7. [Medline].

  24. Janniger CK, Thomas I. Diaper dermatitis: an approach to prevention employing effective diaper care. Cutis. Sep 1993;52(3):153-5. [Medline].

  25. Jordan WE, Lawson KD, Berg RW, Franxman JJ, Marrer AM. Diaper dermatitis: frequency and severity among a general infant population. Pediatr Dermatol. Jun 1986;3(3):198-207. [Medline].

  26. Lin RL, Tinkle LL, Janniger CK. Skin care of the healthy newborn. Cutis. Jan 2005;75(1):25-30. [Medline].

  27. Obalek S, Janniger C, Jablonska S, Favre M, Orth G. Sporadic cases of Heck disease in two Polish girls: association with human papillomavirus type 13. Pediatr Dermatol. Sep 1993;10(3):240-4. [Medline].

  28. Rasmussen JE. Classification of diaper dermatitis: an overview. Pediatrician. 1987;14 Suppl 1:6-10. [Medline].

  29. Scheinfeld N. Diaper dermatitis: a review and brief survey of eruptions of the diaper area. Am J Clin Dermatol. 2005;6(5):273-81. [Medline].

  30. Singalavanija S, Frieden IJ. Diaper dermatitis. Pediatr Rev. Apr 1995;16(4):142-7. [Medline].

  31. Singleton JK. Pediatric dermatoses: three common skin disruptions in infancy. Nurse Pract. Jun 1997;22(6):32-3, 37, 43-4 passim. [Medline].

  32. Sires UI, Mallory SB. Diaper dermatitis. How to treat and prevent. Postgrad Med. Dec 1995;98(6):79-84, 86. [Medline].

  33. Zimmerer RE, Lawson KD, Calvert CJ. The effects of wearing diapers on skin. Pediatr Dermatol. Feb 1986;3(2):95-101. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Rania Dib, MD, Pediatric Senior Specialist, Procare Riaya Hospital, Al Khobar, Saudia Arabia
Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St. Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.