Diaper rash and dermatitis Cutaneous inflammation at the area of skin covered by infant's diaper

Prevalence: Common in infancy 25% of infants.had diaper rash

Factors that increase the risk of diaper rash: 1. Age: High risk at age of 3 – 6 months After 15 months the risk decrease because of more muscular control  does not urinate and defecate as often.

2. Atopic dermatitis: *It is an inflammatory, chronically replacing, Non-contagious, and pruritic skin disorder. *30% of infant with atopic dermatitis had diaper rash. The effect was noted only in infant age 3-6 months rather than older children

3. Diarrhea: In this case the feces is more liquid  spread more readily across the skin  skin damage 4. Type of diaper : *reusable diaper more risk to develop diaper rash. *disposable diaper contain of cellulose or fiber core absorb moisture from urine or feces.

5. Nutritional factors: *K washiorkor: malnutrition usually caused by protein deficiency. *acrodermatitis enteropathica: defective zinc metabolism  causing dermatologic problems. *zinc deficiency, bottle fed babies  suffer From diaper dermatitis more commonly than other

etiology of diaper rash: Occlusion, humidity and friction: When the skin is wetted  the fraction coefficient of the skin increase  more damage from minor abrasion. Contact irritation: Wet skin  decrease the normal barrier and increase the permeability  Allow urine and stool to accelerate skin breakdown

-laundry soap, fabric softener, or bleach used to wash reusable diaper  irritant.contact dermatitis Skin PH and fecal enzymes: *normal skin ph is 4 – 5.5. *Skin occlusion  elevate skin ph *Bacteria on the skin metabolize urine to form ammonia  elevate skin ph *at elevated ph the lipase and protease enzyme found in feces activated 

 skin breakdown due to proteolytic action, increase permeability of the skin to bile salts which cause skin irritation Candidal growth : Candida albicans has extended from infant GIT reservoir to affect the diaper area by feces contact with skin, the recurrence is likely to occur Medical condition: Such as psoriasis, atopic dermatitis, seborrheic dermatitis  diaper dermatitis

Manifestation of diaper dermatitis. most cases are mild & cause no symptom. Visible symptom of diaper rash is mild erythema, seen as shiny patches on the buttock, upper thighs, abdomen, & pubic regions. There is no lesion or ulceration. ◦Candidal rash: satellite lesion with intensive red beefy erythma, and the child shows violent crying when urinate or defecate.

Complication: If diaper dermatitis is not treated  this may lead to bacterial,viral, or fungal infection. Miliaria occur because eccrine sweat duct outflow is disrupted or when sweat is retained.

Prevention 1- role of the diaper Diaper must changed frequently Diaper rash is less in high absorbance diaper 2- cleanliness Washing the diaper area with warm water and mild soap or gentle cleanser and then drying the skin *Chemicals found in diaper wipes can cause skin irritation and this wipes contain alcohol  cause pain to irritant skin

3- skin hydration The skin must not be over hydrated  hasten breakdown of skin But kept moist by using emollient

Diaper rash that is self-treatable is limited to mild skin redness (no lesion or skin damage). Sign of bacterial or fungal infection (ulceration,erosion,lesion)  require referral. If more than 7 days  secondary infection with Candida, especially if the skin is broken  require referral.

Factors considered Nature of diaper (the occlusive nature of diapers helps to facilitate transcutaneous absorption of medication). -Infant don’t metabolize or detoxify medications as well as adult. Many enzyme systems are absent or deficient in neonatal

-The diaper area is relatively large percentage of the infant’s body surface area. Conclusion: Because of all these factors, pharmacists must take great care to use only safe & effective medication

Safe & effective medication. 1. Skin protectants considered the only ingredients safe &effective for diaper rash: 1. Talc( %)  emollient effect on skin, also absorbs sweat. 2. Corn starch (10-98%)  protect skin through absorbent action. 3. Zinc oxide (1-25%)/ Zinc oxide ointment(25-40%).

Cautions : 1. talc & corn starch must be used with caution since it is powder and could cause breathing problems (keep away from child’s face). 2. Don’t use powder on broken skin. 3. avoid Mercury preparation because it is hazardous over a large area. 4. The use of anti fungal, anti bacterial, external analgesics, hydrocortisone should be avoided

In persistent or especially bad rashes, an antifungal cream often has to be used. In cases that the rash is more of an irritation, a mild topical corticosteroid preparation, e.g. hydrocortisone cream, is used

Drug nameActive ingredient company caladermCalamine,dermat ol, zinc oxide شركة القدس Cool oint.Zinc oxide شركة القدس Calamine lotionCalamine, zinc oxide floris Panthe veraD-panthenol, aloe vera pharmix hydrogelD-panthenol,aloe vera, pyridoxine, zinc, vit B6 gikopharm Decomb, dermacombin Neomycin,nystati n, gramicidin, triamcinolone BPC,Taro Baby cureCalamine, zinc oxide, starch GAMA dermagesicCalamine,zinc oxide, benzocaine BJP

desitinCod liver oil, vit A,D, zinc oxide pfizer

Zinc Oxide 10%

Balmex ointment Zinc oxide with Aloe Vera and vit E