Diaper dermatitis

Diaper dermatitis is, as the name implies, an eruption that can be found involving the lower abdomen, proximal thighs, and groin of infants wearing diapers.

The cause is predominantly an irritant dermatitis, although there can be evidence of active Candida overgrowth. Dead Candida organisms are extremely irritating, and probably account for some of the inflammatory reaction. Other irritants such as urine and feces are also factors.

When active Candida infection is present, inflamed pustules can generally be seen.

In children prone to seborrheic dermatitis or sebopsoriasis, there can be a secondary development of these changes in the irritated areas.

Treatment:

• Frequent changing of diapers is indicated, whether cloth or disposable diapers are used. The drier the skin remains, the less likely there will be diaper dermatitis.
• Absorbent disposable diapers provide a drier environment than cloth diapers.
• In addition, cloth diapers, unless well rinsed, can have significant soap retention from past laundering.
• The application of a drying powder, preferably cellulose based, can be helpful.
• A combination of an anti-yeast cream such as miconazole 2% and 1% hydrocortisone cream, applied bid, can reduce the inflammatory reaction quite quickly, irrespective of cause.
• The role of barrier creams is debated. Barrier creams are probably helpful in preventing diaper dermatitis, but are generally not helpful in treating it.

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