Chapter 3: Eczematous Disorders
Diaper Dermatitis
What is it?
Diaper dermatitis is dermatitis occurring in the diaper area. Most commonly this is due to irritation from urine and stool in the moist environment of the diaper, however, there is a longer and important differential diagnosis. The location and morphology of the lesions can help indicate an underlying cause.
| Cause | Clinical Clue |
| Irritant contact dermatitis | Most common. The eruption is erythematous often spares the folds. |
| Allergic contact dermatitis | Confined to exposure area, similar to irritant contact dermatitis. Napkin wipes are potential cause. |
| Candida infection | Erythematous plaques with satellite papules (pustules) favour the folds. |
| Streptococcal infection | Bright red, well-demarcated plaques, that can be painful and can be associated with bad odour. Perianal region most often involved. |
| Psoriasis | Sharply demarcated plaques with scalloped edge. Associated psoriasis in other location including scalp, nails and skin. |
| Seborrheic dermatitis | Usually bright red-orange and can resemble psoriasis. Often seen in conjunction with scalp involvement. |
| Atopic dermatitis | Not commonly seen except in setting of erythroderma. Otherwise diaper area is usually spared. |
| Langerhans cell histiocytosis | Rare. Associated involvement of other locations like scalp and body. They are resistant to treatment. Needs biopsy. |
| Jacquet's dermatitis | An erosive dermatitis, with punched out erosions and ulcers. It is a result of severe irritant contact dermatitis. |
How is it treated?
Understanding the underlying cause can help direct management of diaper dermatitis. For irritant contact dermatitis, barrier protection using zinc-based creams and petrolatum jelly is useful for prevention. They should be applied generously as if icing a cake and should not be completely removed with diaper changes as wiping them off vigorously can damage the underlying skin. If the skin is particularly inflamed, 1% hydrocortisone is useful. Secondary candida infections can occur and can be treated with clotrimazole or other anti-yeast preparations. It should be emphasized that only low potency cortisones should be used under the diaper due to risk of skin thinning with and stronger cortisones. Wipes could also be a source of irritation. Cleaning with water on a soft cloth or mineral oil on a cotton ball are alternatives.
