eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Diaper Rash: Follow-up

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

Follow-up

Further Inpatient Care

  • The following should be admitted to a pediatric ward for further workup.
    • Febrile neonates
    • Toxic appearing patients
    • Children with a severe recalcitrant rash suggestive of immunodeficiency

Further Outpatient Care

  • Arrange for follow-up care with a pediatrician in 1-2 days.

Deterrence/Prevention

  • Expose the buttocks to air as much as possible.
  • Do not use waterproof pants during treatment, as they keep skin wet and subject to rash or infection.
  • Change diapers frequently.
  • Superabsorbent diapers are beneficial.

Complications

  • Because of maceration and abrasion of the skin under the diaper, skin ulceration and secondary infection by C albicans or bacteria are common.
  • Prevalence of a secondary bacterial infection is uncertain, but it is frequent. Multiple organisms, both aerobic and anaerobic, contribute to the development of this condition.
  • Psoriasis id reaction refers to a psoriaticlike eruption of papules and plaques after the initiation of treatment to a candidal infection.
    • Involves the torso and the upper body and usually spares the extremities
    • Occurs days after antifungal therapy is started
    • Is poorly understood but can be treated with low or intermediate potency steroids
  • Jacquet dermatitis is a complicated form of the irritant chafing type of diaper rash.
    • It involves the development of erosive ulcerations with elevated margins.
    • Some nodular patterns also are described in severe chronic irritant dermatitis.
    • Cases remain surprisingly asymptomatic and usually are not secondarily infected.
  • Psoriasiform napkin dermatitis refers to a clinical presentation that combines features of seborrheic and candidal diaper rashes.
  • Secondary bacterial and yeast infections

Prognosis

  • Most cases completely resolve after a concerted effort by the parents toward diaper hygiene.
  • The time to resolution is typically a few days for uncomplicated irritant dermatitis, intertrigo, and miliaria.
  • Candidal infections last a few weeks after treatment is begun.
  • A study by Adalat et al showed that oral thrush was present in 5% of children and had a strongly significant association with a current episode of diaper dermatitis.14
  • At least one half of the cases of atopic dermatitis resolve by the third year of life.
  • Granuloma gluteal infantum tends to resolve spontaneously over the course of a few months.
  • Langerhans cell histiocytosis is usually a fatal disease.

Patient Education

  • The parents of the patient should be educated about proper diaper hygiene and the need for frequent diaper changes to prevent future episodes.
  • Parents should be taught how to recognize changes in the rash indicative of a secondary infection and should be advised to seek medical attention in such instances.
  • For excellent patient education resources, visit eMedicine's Children's Health Center. Also, see eMedicine's patient education articles Diaper Rash, Skin Rashes in Children, and Yeast Infection Diaper Rash.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider serious systemic illness, such as Letterer-Siwe or acrodermatitis enteropathica, especially in a child with physical findings other than rash
  • Prescribing a topical steroid that is too potent for the occlusive environment under the diaper
  • Failure to recognize and treat a bacterial cellulitis
  • Exacerbating a case of herpes zoster by treatment with steroids
 


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
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References

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Further Reading

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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.

 
 
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