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Diaper Dermatitis

Diaper Dermatitis. 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. Epidemiology. 1990-1997: 4.8 million outpatients visits 75% of these in pediatric offices

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Diaper Dermatitis

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  1. Diaper Dermatitis

  2. 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. 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. 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. 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. 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 Differential Diagnosis

  7. 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. You Guess the Diagnosis!

  9. Irritant Diaper Dermatitis Spares skin folds

  10. Candidiasis Satellite lesions In folds of skin

  11. Bullous Impetigo Note erosions of skin

  12. Streptococcal Intertrigo

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

  14. 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 Zinc oxide Zinc oxide Petrolatum Zinc oxide Commonly Used Barrier Creams ACTIVE INGREDIENTS

  15. 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

  16. 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

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