Diaper rash/dermatitis is one of the most common skin disorders in infants and toddlers. Diaper rash may occur at any time, to any child, and to the most meticulous parents. It occurs most frequently between 9 and 12 months of age.
Its etiology is multifactorial and a diaper rash may present in various conditions in the pediatric community. The majority of cases are mild to moderately severe. Diaper rash/dermatitis usually occurs as a primary reaction to irritation by urine, feces, moisture or friction. Proper care and management of diaper rash includes identification of cause, proper assessment and history.
Some common forms of diaper dermatitis are:
- Irritant contact dermatitis – it typically involves the convex surfaces where the skin is in greatest contact with the diaper. It usually spares the inguinal folds, and may be mild red, shiny and with or without papules (elevated solid lesions varying in color).
- Candidal dermatitis – its pattern involves the skin folds and spares the convex surfaces. Mostly rashes appear in the perineal area and may be the result of diarrhea, moisture or a secondary candida infection. The rash is bright red, denuded, containing macules (flat discolored lesions) or papules with satellite lesions, which can be inflamed or painful.
There are several causative theories for diaper rash/dermatitis ranging from food allergies to damage of the stratum corneum (skin’s top layer) such as maceration, friction and chapping. Wetness, dry skin, soaps, elevated pH levels, fecal enzymes, fecal incontinence, and diarrhea due to infection or antibiotic use will alter skin integrity, making the skin more susceptible to diaper dermatitis.
Earlier it was believed that ammonia was the primary cause of diaper dermatitis. However, recent studies have disapproved this by showing that when ammonia or urine is placed on the skin for 24 to 48 hours, no apparent skin damage occurs. Ammonia may be a secondary irritant on damaged skin, but it is probably not a primary cause of diaper dermatitis on intact skin.
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