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Diaper irritant contact dermatitis - Anogenital in
See also in: Overview
Other Resources UpToDate PubMed

Diaper irritant contact dermatitis - Anogenital in

See also in: Overview
Contributors: Sophia Delano MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Irritant diaper dermatitis is a term for dermatitis caused by the occlusion, moisture, and friction produced by diapers or training pants. Once the skin barrier is compromised by this environment, secondary factors such as urinary ammonia, increased urine pH, fecal proteases and lipases, Candida albicans, bacterial overgrowth, and detergent soaps exacerbate the dermatitis.

There have been several reports in the literature of laxative use in infants leading to a severe irritant dermatitis. Laxative-induced diarrhea contained and occluded by a diaper can cause bullae and erosions.

Childhood physical and sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from other benign skin conditions. Perineal irritation and erythema are common causes for concern but are most likely due to irritant contact dermatitis (often caused by diapers), seborrheic dermatitis, poor hygiene, candidal lesions, and excoriation secondary to pruritus. However, severe diaper dermatitis may be a sign of physical neglect if associated with other risk factors. Additional physical findings increasing the possibility of abuse include marked subcutaneous wasting, xerosis due to chronic avitaminosis, and poor hygiene, often with associated pediculosis capitis.

Related topics: Jacquet erosive diaper dermatitis, Diaper dermatitis candidiasis

Codes

ICD10CM:
L22 – Diaper dermatitis

SNOMEDCT:
91487003 – Diaper rash

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

There are many causes of diaper-area rashes. The most common alternative diagnosis in this region is Diaper dermatitis candidiasis. Irritant dermatitis presents with confluent redness in diaper-contact regions with relative sparing in skin folds. Candida presents with pustules and discrete red papules, often found within the folds. In Candida infections, satellite lesions – red papules slightly removed from the main cluster of papules and plaques – are clues to the diagnosis.

Alternative causes include atopic and seborrheic dermatitis (look for rash at distant sites such as the face and scalp for Seborrheic dermatitis and flexural regions for Atopic dermatitis).

Also consider:
  • Allergic contact dermatitis , particularly due to dyes in diapers or ingredients such as methylisothiazolinone in baby wipes.
  • Psoriasis will present as well-demarcated pink plaques that do not spare the skin folds and may be associated with perianal streptococcal infections.
  • Granuloma gluteale infantum (nodules are present)
  • Hereditary acrodermatitis enteropathica, Acquired acrodermatitis enteropathica, and other nutritional deficiencies should be considered in persistent conditions.
  • Langerhans cell histiocytosis (LCH) is a crucial differential diagnosis not to overlook. LCH lesions are petechial papules, often in the skin folds, that do not respond to standard therapies for diaper dermatitis.
Dermatoses unrelated to the presence of a diaper:
  • Perianal streptococcal infection
  • Genital wart
  • Herpes simplex virus
  • Bullous impetigo
  • Molluscum contagiosum
  • Hand, foot, and mouth disease
  • Scabies
  • Nonaccidental trauma (see Physical child abuse and Child sexual abuse)
  • Kawasaki disease
  • Cystic fibrosis
  • Lichen sclerosus
  • Early congenital syphilis
  • Hyperimmunoglobulinemia E syndrome
  • Methylmalonic acidemia

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:11/19/2017
Last Updated:01/16/2020
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Diaper irritant contact dermatitis - Anogenital in
See also in: Overview
A medical illustration showing key findings of Diaper irritant contact dermatitis : Confluent configuration, Diaper area, Erythema, Female genital, Fine scaly plaque, Male genital
Clinical image of Diaper irritant contact dermatitis - imageId=264348. Click to open in gallery.  caption: 'Diffuse, brightly erythematous papules and plaques on the buttocks, lower back, and upper thighs.'
Diffuse, brightly erythematous papules and plaques on the buttocks, lower back, and upper thighs.
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