Practical Management Strategies for Diaper Dermatitis
S. Humphrey, MD; J. N. Bergman, MD, FRCPC; S. Au, MD, FRCPC
Abstract
Common diaper dermatitis is an irritant contact diaper dermatitis(IDD) created by the combined influence of moisture,warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on pratical management strategies for IDD.
Introduction
IDD is a common inflammatory eruption of the skin in the diaper area created by the presence of moisture, warmth, urine, feces, and friction, and is seen in 25% of children wearing diapers.
Common diaper dermatitis is an irritant contact diaper dermatitis(IDD) created by the combined influence of moisture,warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on pratical management strategies for IDD.
Introduction
IDD is a common inflammatory eruption of the skin in the diaper area created by the presence of moisture, warmth, urine, feces, and friction, and is seen in 25% of children wearing diapers.
Pathogenesis
Four key factors contribute to the development of IDD :
- Wetness : Wet diapers result in excessive hydration and maceration of the stratum corneum leading to impaired barrier function, enhanced epidermal penetration by irritants and microbes, and susceptibility to frictional trauma.
- Friction : IDD is most commonly distributed in areas with the greatest skin-to-diaper contact. Mechanical trauma disrupts the macerated stratum corneum, exacerbating barrier dysfunction.
- Urine and feces : The interaction of urine and feces is key to the pathogenesis of IDD. Bacterial ureases in the stool degrade the urea that is found in urine, releasing ammonia and increasing local pH. Fecal lipases and proteases are activated by the increased pH. They cause skin irritation and disruption of the epidermal barrier. Ammonia does not irritate intact skin; it is thought to mediate irritation by contributing to the high local pH.
- Microorganisms : candida albicans (C. albicans) and, less commonly, Staphylococcus aureus (S. aureus) infections are associated with IDD. The warm, humid, and high pH environment in the diaper provides the ideal milieu for microbial proliferation. Innate antimicrobial microflora cannot survive in a high pH environment. There is a positive correlation between the clinical severity of IDD and the presence and level of C. albicans in the diaper, mouth, and anus of infants.
Clinical Features
IDD initially presents with localized asymptomatic erythema, and can progress to widespread painful, confluent erythema with maceration, erosions, and frank ulceration. IDD commonly spares the skin folds, and affects the convex skin surfaces in close contact with the diaper including the buttocks, genitalia, lower abdomen, and upper thighs. IDD complicated by Candida presents with beefy red intertriginous plaques and satellite papules and pustules in the diaper area.IDD complicated by S. aureus appears impetiginized, with erosions, honey-colored crust, and lymphadenopathy.
Granuloma gluteale infantum and Jacquet erosive diaper dermatitis are distinctive, severe variants of IDD. Granuloma gluteale infantum presents in the setting of IDD with violaceous papules and nodules on the buttocks and in the groin.The pathogenesis of granuloma gluteale infantum is not clear. Potential risk factors include treatment with topical steroids, candida infection, and occlusive plastic diaper covers. Granuloma gluteale infantum follows a self-limited course, resolving in weeks to months, often with residual scarring. The presence of punched-out erosions or ulcerations with heaped-up borders characterizes Jacquet erosive diaper dermatitis. This uncommon and severe presentation of IDD typically occurs in the context of frequent liquid stools, poor hygiene, infrequent diaper changes, or occlusive plastic diapers.
It is imperative to consider other conditions that may occur in the diaper area. Several excellent references are available that outline the differential diagnosis of IDD. Please see Table 1 for a review of the clinical features of relevant diaper dermatoses.
DOWNLOAD COMPLETE PDF HERE
IDD initially presents with localized asymptomatic erythema, and can progress to widespread painful, confluent erythema with maceration, erosions, and frank ulceration. IDD commonly spares the skin folds, and affects the convex skin surfaces in close contact with the diaper including the buttocks, genitalia, lower abdomen, and upper thighs. IDD complicated by Candida presents with beefy red intertriginous plaques and satellite papules and pustules in the diaper area.IDD complicated by S. aureus appears impetiginized, with erosions, honey-colored crust, and lymphadenopathy.
Granuloma gluteale infantum and Jacquet erosive diaper dermatitis are distinctive, severe variants of IDD. Granuloma gluteale infantum presents in the setting of IDD with violaceous papules and nodules on the buttocks and in the groin.The pathogenesis of granuloma gluteale infantum is not clear. Potential risk factors include treatment with topical steroids, candida infection, and occlusive plastic diaper covers. Granuloma gluteale infantum follows a self-limited course, resolving in weeks to months, often with residual scarring. The presence of punched-out erosions or ulcerations with heaped-up borders characterizes Jacquet erosive diaper dermatitis. This uncommon and severe presentation of IDD typically occurs in the context of frequent liquid stools, poor hygiene, infrequent diaper changes, or occlusive plastic diapers.
It is imperative to consider other conditions that may occur in the diaper area. Several excellent references are available that outline the differential diagnosis of IDD. Please see Table 1 for a review of the clinical features of relevant diaper dermatoses.
DOWNLOAD COMPLETE PDF HERE
0 comments
Post a Comment