Diaper Dermatitis (Diaper Rash) Clinical Presentation

Updated: Oct 16, 2020
  • Author: Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Children with a previous medical history of eczema or atopic dermatitis may be more susceptible to diaper dermatitis. Cloth diapers and less frequent changes also increase the risk. [13]

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. [14] Low serum zinc level testing should be repeated for laboratory error. Zinc deficiency is easily treated with oral supplements. [15]

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. [16]

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Physical Examination

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. Chronic granulomatous or erosive-appearing lesions can arise from constant maceration. [17, 18]

Children with diaper dermatitis have marked discomfort from intense inflammation.

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

Also consider streptococcal intertrigo. [19, 20]

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Complications

Candidal diaper rash leading to confluent diaper area with tomato-red plaques, papules, pustules, and satellite papules Miliaria rubra evident as tiny red papules and papulovesicles at elasticized openings of the diaper

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