Diaper irritant contact dermatitis - Anogenital in
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Synopsis
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
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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 Candida-induced diaper dermatitis. 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 zinc deficiency, 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.
- Perianal streptococcal infection
- Human papillomavirus
- Herpes simplex virus
- Bullous impetigo
- Molluscum contagiosum
- Hand-foot-and-mouth disease
- Scabies
- Nonaccidental trauma (see physical child abuse and sexual child abuse)
- Kawasaki disease
- Cystic fibrosis
- Lichen sclerosus
- Congenital syphilis
- Hyperimmunoglobulinemia E syndrome
- Methylmalonic acidemia
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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.Subscription Required
References
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Last Reviewed:11/19/2017
Last Updated:01/16/2020
Last Updated:01/16/2020
Patient Information for Diaper irritant contact dermatitis - Anogenital in
Overview
Diaper rash (irritant diaper dermatitis) occurs when an infant's sensitive skin is exposed to urine and stool, coupled with the diaper rubbing and chafing the skin, a tight-fitting diaper, or a diaper being left on too long. Diarrhea can cause or worsen the baby's diaper rash.Who’s At Risk
Diaper rash may occur in anyone who wears diapers. It is an extremely common condition in infants.Signs & Symptoms
Diaper rash appears as flat areas, papules (small, solid bumps), or plaques (bumps larger than a thumbnail), usually limited to any area that is covered by a diaper. The area of skin covered by the diaper will appear red and irritated, except for the skin's folds, which are protected from direct contact with the diaper. Redness may be especially severe where the skin meets the edges of the diaper, and raw, open skin may also be seen in severe cases. In darker skin colors, the redness may be hard to see, but a faint pink, maroon, or darker brown color may be seen, or bumps in the diaper area may be the only clue.Self-Care Guidelines
- Although disposable diapers are superabsorbent and may not necessitate as frequent diaper changes as cloth diapers, changing any diaper often will help keep the area clean and dry. Diapers should usually be changed hourly for newborns and every 3-4 hours for infants.
- When cleaning the diaper area, try using diaper wipes that have no fragrances or extra additives, or use simply water and clean washcloths.
- Avoid scrubbing the diaper area, and pat the area dry instead of rubbing. Use mineral oil (such as Johnson's Baby Oil) or petroleum jelly (such as Vaseline) on a cotton ball to remove dried stool, if needed.
- Applying a barrier cream, such as one with zinc oxide in it (Boudreaux's Butt Paste, Triple Paste, or Desitin), to the diaper area will help reduce friction and skin contact with urine and stool.
- Avoid using harsh soaps on the baby's skin, as well as harsh detergents to wash cloth diapers.
- If possible, allow your baby to have "naked time," where they are free from the diaper, to reduce the amount of time the skin is in contact with diapers.
- The above self-care measures should always be followed to help prevent diaper rash from occurring.
When to Seek Medical Care
See your baby's health professional for evaluation of diaper rash that does not improve with self-care measures or if it is getting worse or developing raw, painful areas. Involvement of the skin folds or any area that is not covered by the diaper may indicate there is another condition and should be evaluated.Treatments
Your baby's health professional may prescribe:- Mild topical corticosteroids to treat inflamed areas of skin. Be careful to prevent thinning of the skin (atrophy) from using steroids in skin folds and covered (occluded) areas by carefully following the instructions given with the corticosteroid.
- Tacrolimus (Protopic) ointment, a nonsteroid ointment, may be prescribed if diaper rash does not improve with other treatments. However, this medication is not approved for use in children younger than 2 years.
- Antifungal or antibacterial creams may also be given if a fungal or bacterial infection has developed in combination with the diaper rash.
Diaper irritant contact dermatitis - Anogenital in
See also in: Overview