II. Etiology

  1. Reaction to friction and maceration
  2. Prolonged contact with urine and feces

III. Symptoms

  1. Infant very uncomfortable with increased inflammation

IV. Signs

  1. Erythematous, scaly dermatitis
  2. Papulovesicular or Bullous lesions
  3. Fissures and erosions
  4. Patchy or confluent
  5. Sparing of genitocrural folds

V. Differential Diagnosis

  1. Candida Diaper Dermatitis (satellite lesions present)
  2. Perianal Streptococcal Dermatitis
  3. Impetigo
  4. Contact Dermatitis
    1. Found on convex surfaces (contrast with candida which is found in skin folds)
    2. Apply thick layer of barrier cream (e.g. Zinc Oxide cream)
  5. Pediatric Seborrheic Dermatitis
    1. Typically associated with Cradle Cap
  6. Rare, refractory cases
    1. Hand-Schuller-Christian Syndrome (Histiocytosis X)
    2. Zinc Deficiency
      1. Acrodermatitis Enteropathica related that manifests after stopping Breast Feeding in infants

VI. Complications

  1. Bacteria or yeast superinfection
  2. Irritant dermatitis superinfected by yeast in 3-5 days

VII. Management

  1. Frequent diaper changes
  2. If possible, let child go without bottoms (keep area dry)
  3. Use disposable diapers
  4. Thorough washing of genitalia with diaper change
    1. Alcohol-free, fragrance-free wipes or
    2. Mild Soap and warm water
  5. Apply occlusive topical agent after washing
    1. Zinc Oxide
    2. Petroleum jelly
    3. Aquaphor
  6. Additional topicals
    1. Topical Corticosteroid (with or without Zinc Oxide)
      1. Hydrocortisone Cream 0.5-1% (or other Level 6-7 Topical Corticosteroids such as Desowen)
      2. Avoid more potent Corticosteroids (Level 5 and less, including Triamcinolone)
      3. Indicated for significant inflammation and use until healing completed
    2. Antifungals
      1. Indicated if superinfection with Candida Diaper Dermatitis suspected
      2. Typically occurs after 4-5 days of Irritant Diaper Dermatitis
      3. Preparations include Clotrimazole, Micoazole and Nystatin
  7. Avoid harmful or unnecessary agents
    1. Avoid systemic antibiotics (not indicated)
    2. Avoid occlusive plastic pants (promotes maceration)
    3. Avoid expensive topicals (e.g. Vusion: 0.25% Miconazole, Zinc Oxide, petrolatum)

VIII. Prevention (especially during times of Diarrhea)

  1. Wash anal area after each stool
  2. Apply vaseline
    1. Apply after each diaper
    2. Apply especially at night and at naptime
  3. Change diaper immediately after each stool

IX. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. (2018) Presc Lett 25(10): 57 [PubMed]

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