Diaper dermatitis is a common dermatitis that presents in 20% of all infants and toddlers in diapers. Its presentation may vary primarily manifesting as erythema and scaling on the surfaces of the inner, upper thigh and buttocks. The creases and mons pubis are usually spared. As the dermatitis progresses it becomes more erythematous with a glistening or glazed and wrinkled surface. It also can manifest as well-demarcated, punched-out ulcers and erosions that occur typically on the labia and more rarely on the penis. If the infant or child has diarrhea, a dermatitis limited to the perianal area may develop. Finally, Candida albicans may secondarily invade and manifest as beefy-red confluent erythematous plaque with a peripheral scale involving the inguinal creases and the genitalia, and small "satellite" oval lesions.
Differential diagnosis
Other forms of dermatitis, or more rarely psoriasis, or Langerhans cell histiocytosis are part of the differential diagnosis for diaper dermatitis.
Pathophysiology
Prolonged exposure to urine and feces is the primary culprit for diaper dermatitis. Feces when mixed with urine produces a rise in pH activated fecal lipases and proteases which in collaboration with Candida albicans causes damage to the epidermis resulting in the loss of the normal barrier.
Treatment
Treatment requires removing urine and feces from the skin surface and keeping it dry. Very frequent diaper changes in combination with lubrication with an emollient or paste such as zinc oxide ointment or petrolatum provides a barrier from the urine and feces. In more severe cases, a mild corticosteroid such as hydrocortisone 1% may be used followed by the emollient. Strong corticosteroids should not be used in the diaper area due to potential for systemic absorption and increased cutaneous atrophy and striae. If candidiasis is suspected, it can be confirmed by obtaining a culture, and adding topical anti-yeast therapy with nystatin in addition to a mild corticosteroid and emollient. The incidence of diaper dermatitis decreases with eight or more diaper changes per day.