Diaper Rash Follow-up

Updated: Nov 09, 2018
  • Author: Rania Dib, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Follow-up

Further Outpatient Care

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

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Further Inpatient Care

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  • 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

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Deterrence/Prevention

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  • 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. [25]

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Complications

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  • 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

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Prognosis

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  • 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. [23]

  • At least one half of the cases of atopic dermatitis resolve by the third year of life.

  • Granuloma gluteale infantum tends to resolve spontaneously over the course of a few months.

  • Langerhans cell histiocytosis is usually a fatal disease.

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Patient Education

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  • 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 patient education resources, see the Children's Health Center, as well as Diaper Rash, Skin Rashes in Children, and Yeast Infection Diaper Rash.

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