Napkin Dermatitis (classical)

Synonyms

Diaper dermatitis; nappy rash; diaper rash.

Definition

Irritant contact dermatitis in diaper region.

Aetiology & Pathogenesis

Disturbance of the epidermal barrier by lipases and proteases from urine and faeces. Skin maceration through moisture and prolonged exposure to alkaline urine and feces under occlusion.

Diaper area particularly prone to suffer disruption from damage (friction), irritation and secondary bacterial or fungal (Candida) infection. Excessive heat, sweat retention, warm local environment and local irritant factors may also play a role.

Signs & Symptoms

Acute to sub-acute dermatitis. Well-demarcated, confluent erythema confined to the diaper area. Skin folds often spared.

Localisation

Area covered by nappies (diapers), typically flexural areas. May involve the inner (frictional) or convex (irritant) surfaces or may be present as a diffuse red erythema on the thighs, genitalia, buttocks and lower abdomen.

Classification

Depending on etiologic factors, such as: frictional (chafing) dermatitis, irritant contact dermatitis, allergic contact dermatitis and diaper candidiasis.
Grading: mild, moderate or severe.

Laboratory & other workups

Clinical diagnosis. Tests usually not necessary in refractory cases, however, swabs may useful in detecting a superimposed bacterial or fungal infection.

Dermatopathology

Not necessary.

Course

Diaper dermatitis responds well to treatment. Recurrence may be present if preventive measures are not undertaken.

Complications

Superinfection (Candida, streptococci), allergic contact dermatitis.

Diagnosis

History, clinical features. KOH examination to exclude candidiasis and microbial swab for streptococci.

Differential diagnosis

Atopic dermatitis, seborrheic dermatitis, candidiasis, perianal streptococcal dermatitis, allergic contact dermatitis and psoriasis should be considered. Rarely Langerhans cell histiocytosis and nutritional deficiency (acrodermatitis enteropatica).

Prevention & Therapy

Preventive measures (parental advice on napkin care):.

Frequent diaper changes and optimize the size of the diaper. Keep the skin clean and dryunder the diaper
ProtectiInfant skin from irritants and prevent napkin dermatitis. Avoid potential skin irritants (soaps, detergents perfumed products and alcohol/fragrance-containing products)
Advise to wash with an emollient soap-free, fragrance-free liquid cleanser, or warm water
Use good-quality super-absorbent napkins and apply barrier compounds (creams, ointments or pastes) which protect skin from exposure to moisture.

For clinicians:

Treat secondary infections
Short-term mild topical corticosteroids

1.1.2.6 Napkin Dermatitis (classical)