Diaper dermatitis

Background

Irritant contact dermatitis - the most common skin disorder in infants^[1]
Caused by presence of urine, feces, moisture, friction → breakdown of skin barrier
Breast-feeding associated with lower rates of severe diaper dermatitis^[1]

Contact diaper dermatitis

Erythematous, macular and/or papular rash with well demarcated borders
More severe disease will also have skin maceration and erosions
Candidal rash will include scaling around margins
- Classic finding is "satellite lesions" in other locations
- Also examine for oral thrush

Hygiene
- Air drying
- Cleansing regimen (gentle cleaning with water or soap)
- Superabsorbent gel diapers
- Frequent changing
- Barrier creams (zinc oxide)
- Powders (but caution due to risk of aspiration)
Topical corticosteroids (if resistant to hygiene measures)^[1]
- Hydrocortisone cream BID (for no longer than 2 weeks)
- Absorption increased due to moisture and diaper (Cushing syndrome has been reported with overuse)
Antifungal cream (if suspect candida dermatitis)^[1]
- Nystatin cream 100,000 U/gram TID x10-14d (If using zinc oxide cream, apply after nystatin)
- Other options include: clotrimazole, ketoconazole, miconazole, oxiconazole, econazole, sertaconazole
  - Miconazole 0.25% cream to affected area with each diaper change x 7 days
  - Econazole 1% cream to affected area BID, continue for 3 days after resolution
Antibacterial therapy (if suspect bacterial infection)^[1]
- Mupirocin, bacitracin, polysporin, retapamulin

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr;61(2):367-82.