Kembara Xtra - Medicine - Diaper Dermatitis A rash under a diaper's covered region is known as diaper dermatitis (called for its typical location rather than its cause). It usually starts off as a contact irritant dermatitis, although systemic problems can cause it or make it worse. Skin/exocrine system is impacted. Diaper rash, nappy rash, and napkin dermatitis are synonyms. Aspects of Geriatrics In the senior population, incontinence is a key contributing element. Incidence and prevalence in Epidemiology Peak incidence occurs between 7 and 12 months of age, then incidence declines. Breastfed infants have a decreased incidence because to lower pH, urease, protease, and lipase activity. Prevalence The prevalence in the first two years of life has been found to range widely from 4% to 35%. In the United States, up to 75% of babies will experience episodes of different length and severity. 58% of symptoms are mild, 34% are moderate, and 8% are severe. The impact of the illness is difficult to assess because of underreporting. Pathophysiology and Etiology Infant skin is histologically, biochemically, and functionally different from mature skin. Wet skin plays a key role in the emergence of diaper dermatitis because prolonged exposure to urine or feces increases the risk of chemical, enzymatic, and physical damage. Wet skin is also more permeable. Fecal lipase and protease activity is increased by acceleration of GI transit, and as a result, a higher incidence of irritant diaper dermatitis is seen in infants who have had diarrhea in the previous 48 hours. Additionally, fecal proteases and lipases are irritants, and the superhydrase urease enzyme found in the stratum corneum liberates ammonia from cutaneous bacteria. Candida albicans secondary infection is frequent once the skin has been weakened. C. albicans is present in 40–75% of diaper rashes that last longer than three days. Allergies are incredibly uncommon as a cause of diaper dermatitis in babies. Bacteria may contribute to diaper dermatitis through the lowering of fecal pH and subsequent activation of enzymes. Risk factors include few diaper changes, improper washing of cloth diapers, dermatitis in the family, hot, muggy weather, recent treatment with oral antibiotics, diarrhea (more than three stools per day increases risk), dye allergy, and eczema. Prevention Most successfully controlled through preventive, which includes paying close attention to hygiene Associated Conditions Psoriasis, candidiasis, contact (allergic or irritating) dermatitis, seborrheic dermatitis, atopic dermatitis Diagnosis The key is a correct diagnosis. Verify if there are no stigmata of systemic disorders. several than contact irritant dermatitis, several diseases may first manifest themselves in the diaper region. By doing a suitable general skin examination, you can prevent presuming that all diaper-area dermatitis is straightforward contact/irritant dermatitis. Presenting History Contact with infants who have a similar rash Recent illness, diarrhea, or antibiotic usage Fever Pustular drainage Lymphangitis Rashes outside the diaper area Onset, length, and change in the type of the rash Rashes associated with scratching or crying clinical assessment Shiny erythema scale is the main feature of mild types. Marginality is not always obvious. Areas of papules, vesicles, and minor surface erosions can be found in moderate instances. It affects the prominent areas of the buttocks, medial thighs, mons pubis, and scrotum, and can proceed to well-defined ulcerated nodules that are about 1 cm in diameter. Skin folds are spared or affected last. Diaper dermatitis can result in an id response (autoeczematous) outside the diaper area. Tidemark dermatitis is the bandlike form of erythema of inflamed diaper borders. Differential diagnosis: Contact dermatitis, seborrheic dermatitis, candidiasis, atopic dermatitis, scabies, acrodermatitis enteropathica (zinc deficiency), Letterer-Siwe disease, congenital syphilis, child maltreatment, streptococcal/staphylococcal infection, Kawasaki disease, biotin deficiency, psoriasis, Laboratory Results Rarely required are initial tests (lab and imaging). Tests in the Future & Special Considerations Take into account a potassium hydroxide (KOH) preparation or a culture of the lesions. Finding mites, ova, or feces on a mineral oil preparation of a burrow scraping might confirm the diagnosis of scabies. Finding anemia in conjunction with hepatosplenomegaly and the proper rash may suggest a diagnosis of Langerhans cell histiocytosis or congenital syphilis. Interpretation of Tests Histology may show acute, subacute, or chronic spongiotic dermatitis. Biopsy is uncommon. Treatment The key to treating this illness is prevention. Prevention Techniques Give the buttocks as much air exposure as you can. Use a gentle, slightly acidic, or neutral pH cleaner with water; pat the area dry without rubbing. Avoid wearing impermeable waterproof pants while receiving therapy (day or night); they keep the skin wet and can cause an infection or rash. If the rash is severe, change diapers regularly, even at night. Super-absorbent diapers are advantageous because they drain pee away from skin while yet allowing air to pass through. Manufacturer-related information suggests that diapers with a mesh-like top sheet design may be better at separating stool from skin. Stop using baby oil, lotion, powder, ointment, or anything containing zinc oxide. Using suitably prepared baby wipes (fragrance- and alcohol-free) is equally safe and efficient as using water. Baby wipes that are advertised as safe for sensitive skin seem to work just as well overall. At the first indication, apply Desitin® or Balmex® or another barrier cream containing zinc oxide BID or TID to the rash. Apply on clean, completely dry skin afterwards. Cornstarch is able to lessen friction. Avoid products that include talcum. First Line of Medicine A low-potency topical steroid (hydrocortisone 0.5-1% TID for 3 to 5 days) and removal of the offending agent (urine, feces) should be sufficient for treating pure contact dermatitis. Use an antifungal such as miconazole nitrate 2% cream, miconazole powder, econazole (Spectazole), clotrimazole (Lotrimin), or ketoconazole (Nizoral) cream at each diaper change if candidiasis is suspected or diaper rash persists. Persistent dermatitis in the moist diaper area frequently has a secondary Candida superinfection. Consider using an antifungal cream with a very low-potency steroid cream, such as clioquinol-hydrocortisone (Vioform-Hydrocortisone) cream, in combination if the inflammation is severe. Use an antistaphylococcal oral antibiotic or mupirocin (Bactroban) ointment topically if a subsequent bacterial infection is suspected. Avoid using high- or moderate-potency steroids in the diaper area. These are frequently encountered in combination with steroid antifungal combinations. Sucralfate paste as a backup treatment in cases of resistance According to a recent study, using hydrocolloid dressings to rashes may hasten their healing. In refractory situations, case reports suggest the use of immune modulators like topical tacrolimus (0.03%); however, this medication is not recommended for children under the age of two. American Academy of Allergy and American College of Allergy recently reviewed the literature and found no evidence that suggested danger. Concerns To Refer To If a systemic illness like HIV infection, acrodermatitis enteropathica, or Langerhans cell histiocytosis is detected, take this into account. Admission Admission requirements/initial stabilization - Febrile neonates - Recalcitrant rash suggestive of immunodeficiency - Toxic-appearing infants Assist new parents with hygiene instruction. Patient Follow-Up Monitoring Recheck every week until it is clear, then at reoccurring times. To effectively treat and stop recurrent occurrences, patient education is essential. With the right care, the prognosis is for rapid and full clearing; nevertheless, secondary candidal infections may persist for a few weeks after treatment has started. Complications Consider community-acquired methicillin-resistant Staphylococcus aureus [MRSA] if you have pustular dermatitis that is not responding to standard treatment. Inoculation with group A-hemolytic Streptococcus can occasionally result in a condition called necrotizing fasciitis. An further yeast infection
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