Diaper Rash

Basics

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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