Diaper Dermatitis Clinical Presentation

  • Author: Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 4, 2011
 

History

Children with a previous medical history of eczema or atopic dermatitis may be more susceptible to diaper dermatitis.

Nutritional history may also be an important factor to consider in diaper dermatitis. A biotin-poor diet, such as occurs with elemental formula alone, may result in perioral erythema, developmental delay, loss of hair, and hypotony (in addition to diaper dermatitis). Lack of zinc-binding ligands in the intestine, such as in the autosomal recessive disorder acrodermatitis enteropathica, may result in a triad of hair loss, dermatitis, and diarrhea. Generally, a decrease in zinc in the diet may be associated with relative alopecia and diaper dermatitis. One study found the lowest levels of zinc in the hair of infants aged 8 months.[3] Low serum zinc level testing should be repeated for laboratory error. Zinc deficiency is easily treated with oral supplements.[4]

Another factor to consider in a child's medical history is the immune status; patients who are immunocompromised are more susceptible to infections by C albicans and other bacterial superinfections.

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Physical

Patients with diaper dermatitis present with an erythematous scaly diaper area often with papulovesicular or bullous lesions, fissures, and erosions.

The eruption may be patchy or confluent, affecting the abdomen from the umbilicus down to the thighs and encompassing the genitalia, perineum, and buttocks. Genitocrural folds are spared in irritant dermatitis, but often involved in primary candidal dermatitis.

Children with diaper dermatitis have marked discomfort from intense inflammation.

Rule out a secondary yeast or bacterial infection, which may occur in the area.

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Causes

The following causes have been noted:

  • Overhydration of the skin
  • Maceration
  • Prolonged contact with urine and feces
  • Retained diaper soaps
  • Topical preparations
  • More than 3 diarrheal stools per day
  • Side effects of oral antibiotics
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Contributor Information and Disclosures
Author

Ruchir Agrawal, MD  Chief, Allergy and Immunology, Aurora Sheboygan Clinic

Ruchir Agrawal, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Vijay Sammeta  MD, Medical Information Services, Adventis Pharmaceutical

Disclosure: Nothing to disclose.

Isabelle Thomas, MD  Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange

Isabelle Thomas, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

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.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Runeman B. Skin interaction with absorbent hygiene products. Clin Dermatol. Jan-Feb 2008;26(1):45-51. [Medline].

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

  3. Collipp PJ, Kuo B, Castro-Magana M, et al. Hair zinc, scalp hair quantity, and diaper rash in normal infants. Cutis. Jan 1985;35(1):66-70. [Medline].

  4. Benedix F, Hermann U, Brod C, et al. [Transient zinc deficiency in preterm infants]. Hautarzt. Jul 2008;59(7):563-6. [Medline].

  5. Xhauflaire-Uhoda E, Henry F, Pierard-Franchimont C, Pierard GE. Electrometric assessment of the effect of a zinc oxide paste in diaper dermatitis. Int J Cosmet Sci. Oct 2009;31(5):369-74. [Medline].

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

  7. Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. Mar 1994;11(1):18-20. [Medline].

  8. Boiko S. Treatment of diaper dermatitis. Dermatol Clin. Jan 1999;17(1):235-40, x. [Medline].

  9. Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin North Am. Aug 2000;47(4):757-82. [Medline].

  10. Ferrera PC, Dupree ML, Verdile VP. Dermatologic problems encountered in the emergency department. Am J Emerg Med. Oct 1996;14(6):588-601. [Medline].

  11. Gokalp AS, Aldirmaz C, Oguz A, et al. Relation between the intestinal flora and diaper dermatitis in infancy. Trop Geogr Med. Jul 1990;42(3):238-40. [Medline].

  12. Higuchi R, Mizukoshi M, Koyama H, et al. Intractable diaper dermatitis as an early sign of biotin deficiency. Acta Paediatr. Feb 1998;87(2):228-9. [Medline].

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

  14. Kazaks EL, Lane AT. Diaper dermatitis. Pediatr Clin North Am. Aug 2000;47(4):909-19. [Medline].

  15. Lane AT. Resolving controversies in diaper dermatitis. In: Contemporary Pediatrics. Vol 3. 1986:45-55.

  16. Longhi F, Carlucci G, Bellucci R, et al. Diaper dermatitis: a study of contributing factors. Contact Dermatitis. Apr 1992;26(4):248-52. [Medline].

  17. Manzoni P, Gomirato G. [Effectiveness of topical acetate tocopherol for the prevention and treatment of skin lesions in newborns: a 5 years experience in a 3rd level Italian Neonatal Intensive Care Unit]. Minerva Pediatr. Oct 2005;57(5):305-11. [Medline].

  18. Martin E. Weisse Stephen C. Aronoff. Candida. In: Kliegman. Nelson Textbook of Pediatrics. 18th ed. Saunders; 2007:231.

  19. Metry DW, Hebert AA. Topical therapies and medications in the pediatric patient. Pediatr Clin North Am. Aug 2000;47(4):867-76. [Medline].

 
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A 3-week-old female infant with diaper rash. Satellite lesions can be observed. The patient was diagnosed clinically with candidal dermatitis and successfully treated with nystatin ointment.
 
 
 
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