Diaper Rash Workup

  • Author: Rania Dib, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: May 15, 2012
 

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.
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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.
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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.
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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, Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, Department of Emergency Medicine, American University of Beirut, Lebanon

A Antoine Kazzi is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

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.

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.

References

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Diaper rash.
Diaper rash.
Diaper rash.
Diaper rash pathophysiology scheme.
Table. Skin Care Ingredients Found in Diaper Rash Creams, Ointments, and Pastes
Several products are available for the care, management, and maintenance of skin integrity. The following are examples of ingredients frequently found in skin care products.
PetrolatumSkin protectant, water repellant, a barrier
Zinc oxideSkin protectant, soothes irritated skin
DimethiconeSkin protectant
Vitamins A and DSkin conditioner
KarayaViscosity modifier and absorbs moisture
Mineral oil, lanolin, glycerinEmollient, softens and soothes irritated skin, a lubricant



Humectant, hygroscopic (brings water to the surface of the skin producing a moisturizing effect)



Vitamin E acetateSkin conditioner
Isopropyl palmitateSkin conditioner
Purified waterDiluent
Chloroxylenol (PCMX)Antimicrobial, kills or inhibits bacteria
Isopropyl alcoholAntimicrobial
Miconazole nitrateAntifungal
Carboxymethylcellulose sodiumViscosity modifier
Methyl glucose dioleateEmulsifier, added to water-oil preparations to prevent the oil from separating from the water
Stearate acidEmulsifier
ButylparabenPreservative, prevents breakdown of product and destroys or prevents growth of bacteria
MethylparabenPreservative
TriethanolaminepH adjuster (normal pH of skin is 4.5-5.5)
Aminomethyl propanolpH adjuster
Cetyl alcoholEmollient and thickening agent
Adapted from Pediatr Nurs. 2004 Nov-Dec; 30(6): 467-70.[10]
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