Diaper Rash



  • Very common dermatologic disorder of infancy
  • Most common in first month of life and again at 9–12 mo
  • May account for up to 25% of dermatology visits to health care providers during the first year of life
  • Incidence in adult incontinent patients is reported from 5.7% to more than 42% and appears to be strongly associated with age
  • Primary irritant/contact dermatitis:
    • Outer skin layers are broken down, leading to inflammation, impairment of normal skin microflora, and loss of protective barrier function
    • Increased skin moisture encourages growth of microorganisms on the surface of the skin
    • Secondary fungal or bacterial infection can cause more severe forms of diaper dermatitis
  • Also known as diaper dermatitis


  • Irritants:
    • Moisture:
      • Prolonged overhydration owing to infrequent diaper changes, poorly absorbing diapers or cloth diapers, urinary or fecal incontinence in adults
    • Friction:
      • Diaper rubbing on skin or loose-fitting diaper
    • Chemicals:
      • Prolonged exposure to stool enzymes and urine
      • Scents or moisturizers in wipes or soap that are corrosive such as a strong acid or alkali
      • Diaper material or adhesive used to hold diaper in place
  • Infection:
    • Candida albicans:
      • Isolated in up to 80% of infants
      • Overgrowth common after systemic antibiotic use
    • Bacterial:
      • Often complication of other causes of dermatitis: Staphylococcus aureus, Streptococcus, Escherichia coli are common; Peptostreptococcus and Bacteroides may also be encountered
      • Perianal streptococcal dermatitis
    • Viral (HSV and enterovirus are the most common)
  • Seborrheic diaper dermatitis
  • Psoriasis
  • Allergic diaper dermatitis (contact dermatitis)
  • Risk factors:
    • Oral thrush
    • Number of previous episodes of diaper rash
    • Duration of use of diapers
    • Diarrhea

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