diaper dermatitis l.
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Diaper Dermatitis. Objectives. Be able to identify common infant diaper rashes Understand the factors involved with causing irritant diaper dermatitis Know how to treat the common diaper rashes. Epidemiology. 1990-1997: 4.8 million outpatients visits 75% of these in pediatric offices

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Presentation Transcript
objectives
Objectives
  • Be able to identify common infant diaper rashes
  • Understand the factors involved with causing irritant diaper dermatitis
  • Know how to treat the common diaper rashes
epidemiology
Epidemiology
  • 1990-1997: 4.8 million outpatients visits
    • 75% of these in pediatric offices
  • Peak ages: 9-12 months
  • Often associated with Candida albicans
    • Higher severity associated with C. albicans
factors involved in development
Factors Involved in Development
  • Combination of:
    • Diaper occulsion
    • Fecal enzyme activity activity
    • Urine
    • Diaper chaging
  • Leads to:
    • Overhydration of the stratum corneum
    • Chemical and mechanical abrasion
    • Susceptibility to penetration of irritants and microbes
role of urine and feces
Role of Urine and Feces
  • Interaction of urine and feces is fundamental in the development of IDD (Irritant Diaper Dermatitis)
  • Bacterial ureases in stool degrade urea in urine thus releasing ammonia
    • Ammonia does not irritate skin but increases local pH which reactivates fecal enzymes such as lipase and protease which irritate skin
differential diagnosis
Inflammatory

Contact Dermatitis

Allergic Dermatitis

Intertrigo

Seborrheic Dermatitis

Atopic Dermatitis

Psoriasis

Granuloma gluteale infantum

Malignancy

Langerhans’ cell histiocytosis

Miscellaneous

Miliaria

Child Abuse

Infectious

Candidiasis

Folliculitis

Bullous impetigo

Perianal/Intertriginous streptococcal disease

HSV

Scabies

Congenital Syphilis

Nutritional/Metabolic

Acrodermatitis enteropathica

Biotin Deficiency

Cystic Fibrosis

Differential Diagnosis
characteristics
Characteristics
  • Irritant Diaper Dermatitis
    • Confluent erythematous papules
    • Scaling
    • Skin Folds Spared
  • Candidiasis Associated
    • Rash > 3 days
    • Irregular, scaly border
    • Satellite lesions
    • Skin Folds involved
candidiasis
Candidiasis

Satellite lesions

In folds of skin

bullous impetigo
Bullous Impetigo

Note erosions of skin

management of idd
Management of IDD
  • Nonmedical
    • Frequent diaper changes
    • Gentle cleansing
    • Barrier protection
  • Medical
    • Anti-inflammatory  low potency steroids
    • Anti-fungal  lotrimin, nystatin
commonly used barrier creams
Vitamin A&D ointment

Aquaphor

Aveeno diaper cream

Balmex ointment

Boudreaux’s paste

Desitin

Triple Paste

Zinc Oxide ointment

Vit. A & D, lanolin

Petrolatum, lanolin

Zinc oxide, dimethicone

Zinc oxide

Zinc oxide

Zinc oxide

Petrolatum

Zinc oxide

Commonly Used Barrier Creams

ACTIVE INGREDIENTS

cleansing
Cleansing
  • Avoid wipes with alcohol product
  • Nonirritating cleansers: cetaphil or mineral oil
  • Do not entirely wipe away barrier preparation – wipe away feces and replace what barrier is removed
  • Powders?
    • Cornstarch is recommended over talcum powder
    • Talcum powder associated with severe respiratory distress caused by inhalation
corticosteroid use
Corticosteroid Use
  • Low potency steroids relatively safe
  • Mid to High Potency corticosteroids
    • Generally contraindicated in occluded areas of the skin and can cause skin atrophy, striae, tachyphylaxis, and growth delay
    • Abraded skin also increases absorption rates