Chapter 117: Diaper Rash and Perianal Dermatitis

PATIENT STORY

A 2-month-old baby girl was brought to the office with a severe diaper rash that was not getting better with Desitin. Upon examination, the physician noted a white coating on the tongue and buccal mucosa. The diaper area was red with skin erosions and satellite lesions (Figure 117-1). History and physical are consistent with candidiasis of the mouth (thrush) and the diaper region. The child was treated with oral nystatin suspension and topical clotrimazole cream in the diaper area with good results.

INTRODUCTION

Diaper rash is a general term used to describe any type of red or inflammatory skin rash that is located in the diaper area.

SYNONYMS

Diaper dermatitis, napkin dermatitis.

EPIDEMIOLOGY

• Diaper dermatitis is the most common dermatitis of infancy.

• Variability in prevalence of 4% to 35% among children in their first 2 years of life in different studies.¹

• Diaper rash is thought to be present in 25% of children presenting for outpatient visits.²

• No differences in prevalence between genders or among ethnic groups.

• One study showed an incidence of 19.4% in children ages 3 to 6 months.¹

• Higher incidence among formula-fed compared with breastfed infants.¹

• Condition typically begins around age 3 weeks, peaks at age 9 to 12 months, and then decreases with age until it resolves completely with toilet training.³

• Individual episodes last from 1 day to 2 weeks.

• Aggravating factors include poor skin care, diarrhea, recent antibiotic use, and urinary tract abnormalities.

• Perianal streptococcal dermatitis occurs in children between 6 months and 10 years of age (Figures 117-2 and 117-3).

ETIOLOGY AND PATHOPHYSIOLOGY

• Primary diaper dermatitis—An acute skin inflammation in the diaper area with a multifactorial etiology.⁴ The main cause is irritation of thin skin as a result of prolonged contact with moisture including feces and urine. The multiple factors involved are:

  1. Occlusion/lack of exposure to air.

  2. Friction and mechanical trauma.

  3. Local irritants—Fecal proteases and lipases.

  4. Increased pH.

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