1. Continuity Clinic Diaper Dermatitis

2. Continuity Clinic 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

3. Continuity Clinic 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

4. Continuity Clinic 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

5. Continuity Clinic 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

6. Continuity Clinic 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

7. Continuity Clinic Characteristics Irritant Diaper Dermatitis –Confluent erythematous papules –Scaling –Skin Folds Spared Candidiasis Associated –Rash > 3 days –Irregular, scaly border –Satellite lesions –Skin Folds involved

8. Continuity Clinic You Guess the Diagnosis!

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10. Irritant Diaper Dermatitis Spares skin folds

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12. Candidiasis Satellite lesions In folds of skin

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14. Bullous Impetigo Note erosions of skin

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16. Streptococcal Intertrigo

17. Continuity Clinic Management of IDD Nonmedical –Frequent diaper changes –Gentle cleansing –Barrier protection Medical –Anti-inflammatory  low potency steroids –Anti-fungal  lotrimin, nystatin

18. Continuity Clinic 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 Petrolatum Zinc oxide ACTIVE INGREDIENTS

19. Continuity Clinic 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

20. Continuity Clinic 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