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Etiologic factors in diaper dermatitis: the role of feces.

While the etiology of diaper dermatitis in infants is complex, it is generally believed to involve an interaction between skin and irritants in feces and urine. Proteases and lipases were identified as the major irritants in the feces of infants, and bile salts were found to potentiate the damage produced by the action of fecal enzymes on skin. Fecal enzymes also increased the permeability of skin, thereby increasing potential susceptibility to other irritants in the diaper environment.

Animals↗

Infantile psoriasis: a follow-up study.

The appearance of psoriasis in infancy has been questioned by many dermatologists and pediatricians, although childhood psoriasis is a well-recognized entity. To elicit further information on this matter, a follow-up group of nine children who had been diagnosed initially as having infantile psoriasis was reexamined 6 to 13 years later to determine the course of the disease over time. Seven of the nine children had recurrent psoriatic lesions and two remained completely clear after the resolution of the initial eruption. The majority did not have a severe disease course; on the contrary, progression of the illness was mild for most of them. Familial aggregation was noted in almost all of the children. In fact, over the intervening years the number of relatives with psoriasis significantly increased. Most patients were not aware of the role of such factors as infections, injury, and stress in precipitating psoriasis. Participation in a self-help workshop is recommended as a way for both parents and children to learn to cope with the clinical and psychologic aspects of the illness.

Age Factors↗

Effects of diaper types on diaper dermatitis associated with diarrhea and antibiotic use in children in day-care centers.

Infants and toddlers in day-care centers have a relatively high frequency of diarrhea and/or oral antibiotic use, and may be at increased risk of developing diaper dermatitis when diapered. A six-month, prospective, double-blind study was conducted in day-care centers in Houston, Texas, to determine the frequency of diarrhea, antibiotic use, and diaper dermatitis in infants and toddlers wearing conventional (cellulose-only core) disposable diapers or disposable diapers with a core of absorbent gelling material (AGM) and cellulose. A questionnaire was administered weekly to the day-care staff to gather health information, and weekly visual examinations were made of children for diaper dermatitis. The frequency of diarrhea was 1.9 episodes per child-year and that of antibiotic use was 3.3 courses per child-year. Infants diapered in disposable diapers with AGM had a significantly (P 0.032) lower mean grade of diaper dermatitis during diarrhea episodes and a lower (P 0.054) mean grade during antibiotic use, compared to those diapered in conventional disposable diapers. There was no significant difference between groups with regard to isolation of Staphylococcus aureus or Candida albicans from superficial skin cultures of the diapered area. The results indicate that diarrhea and antibiotic use occur frequently in children in day-care centers, and that the severity of diaper dermatitis is less in children wearing AGM disposable diapers than those wearing conventional disposable diapers in that setting.

Anti-Bacterial Agents↗

Autoinoculated palmar pustules in neonatal candidiasis.

A 2-week-old infant had grouped pustules on the right hand, wrist, and antecubital flexure that appeared after the first week of life. The infant was seen repeatedly to suck the involved areas of the hand and wrist. Clinically typical candidiasis was noted in the oral cavity and the diaper area. Wright's-stained smears of pustular contents, potassium hydroxide preparations of pustular material, and scale from the diaper dermatitis confirmed the presence of pseudohyphae and budding yeasts in all the involved sites. This case demonstrates fairly typical manifestations of neonatal-onset candidiasis, with the unusual feature of unilateral upper extremity pustules that appeared to represent an autoinoculated cutaneous infection.

Candidiasis, Cutaneous↗

Diaper performance: maintenance of healthy skin.

Skin wetness is proportional to diaper wetness, and with increased skin wetness, the potential for diaper dermatitis is increased. This study evaluated a wide range of infant diaper products. Eighty healthy volunteers wore 2-inch wetted diaper patches on their volar forearm for two hours. An evaporimeter was used to measure excess skin wetness attributed to the patches. The amount of moisture retained in the patch was also calculated. We found that superabsorbent (SA) disposable diapers kept the skin drier and retained more synthetic urine than cloth reusable and conventional disposable brands, and thus have the greatest potential for helping prevent diaper dermatitis. The SA brands evaluated did an equally adequate job in keeping the skin dry and in retaining moisture. Conventional disposable diapers were less able to keep the skin dry than SA diapers and were not superior to cloth products in most instances. Cloth diapers' performance depended on their composition. Those with several layers of the same fabric were less successful in keeping the skin dry than ones that contained middle layers of different nonwoven components.

Diaper Rash↗

Granuloma gluteale infantum: case report and review of the literature.

Granuloma gluteale infantum, a benign granulomatous eruption involving the gluteal region, histologically shows a nonspecific dermal inflammatory infiltrate composed of neutrophils, lymphocytes, histiocytes, plasma cells, and eosinophils. It is important to recognize this condition, as it may clinically simulate a neoplastic process. It arises as a complication of primary irritant diaper dermatitis, however, and typically resolves without treatment.

Biopsy↗

Jacquet erosive diaper dermatitis in a young girl with urinary incontinence.

We report a case of Jacquet erosive diaper dermatitis (dermatitis syphiloides posterosiva) in a 9-year-old girl suffering from urinary incontinence due to an ectopic opening of a left double ureter into the vaginal vestibule. The toilet paper that she used as an absorbent was thought to be one of the factors causing the eruption. The lesions cleared with topical application of a nonsteroidal antiinflammatory ointment and zinc oxide ointment, in conjunction with the use of sanitary napkins.

Child↗

Association of skin wetness and pH with diaper dermatitis.

The strength of the association between diaper dermatitis and measurements of skin wetness and skin pH was evaluated by statistical analysis of four diaper trials involving 1601 infants. Although the strength of the association between skin wetness and diaper dermatitis was greater than that between skin pH and diaper dermatitis, increases in wetness and pH were both significantly associated with elevated mean grades for diaper dermatitis. The skin environment least likely to be associated with diaper dermatitis is one in which increases in both skin wetness and skin pH are minimized.

Body Water↗

Diaper dermatitis that does not quit.

Diaper dermatitis is one of the most common skin disorders in infants. The humid, moist environment under the diaper makes the skin more susceptible to injury from exposure to irritants particularly related to urine and feces. A gentle cleansing routine, frequent diaper changes, and a thick barrier cream help control this condition. Irritant diaper dermatitis should be distinguished from other skin conditions that may develop in this sensitive area.

Administration, Topical↗

Diaper dermatitis: a study of contributing factors.

A 44-week clinical study was carried out on a large sample of the Italian infant population to measure the incidence of diaper (napkin) dermatitis and to identify the factors related to the development of diaper dermatitis. Factors such as age, sex, the presence of atopic dermatitis, the general state of health of the child, the use of drugs and the type of diaper used were recorded. At the end of the test, 2169 clinical dermatological examinations were performed. The frequency of episodes of diaper dermatitis was 15.2%. Statistical correlations between diaper dermatitis and age, presence of atopic dermatitis, and health conditions were found.

Age Factors↗

The histopathology of diaper dermatitis. Historical review.

The precise pathogenesis of one of the most common cutaneous disorders, diaper dermatitis, has not yet been completely established, perhaps in part because relatively little histopathological knowledge has been obtained. This paper summarizes the available information in this field, mostly obtained by early investigators.

Diaper Rash↗

Deadly diapers.

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Boric Acids↗