Symptoms
Inflammatory reactions in the diaper area:
- Reddened, wet, scaly erosions.
- Often shiny surface
- Vesicles and pustules
- Itching
- Painful open skin
Diaper dermatitis with candida infection:
- Sharply demarcated, moist shiny skin redness in the folds of the buttocks and genital area.
- Scaly fringe at the transition zones to the healthy skin.
- Scattering of pinhead-sized nodules or pustules in the marginal area (satellite papules).
Diaper dermatitis with a bacterial infection:
- Weeping redness of the skin
- Pustules and blisters
- In severe cases: open, bleeding skin areas.
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History
Diaper dermatitis can vary greatly in severity. It can also affect only the immediate area around the genitals or extend to the lower abdomen and thighs. With appropriate treatment, diaper dermatitis heals within a few days. In severe cases, ulcers appearing as if punched out (jaquets dermatitis) occur around the edges.
Causes
1. moisture and heat: softening of the skin, disruption of the protective function of the skin 2. urine and faeces: warm, moist environment, high pH, fecal enzymes, toxic substances 3. friction: mechanical stress 4. microorganisms: usually , rarely bacteria (esp. )
- Concomitant diseases, e.g. diarrhea, allergies, immune deficiency, cystic fibrosis, etc.
- Infrequent diaper changes, lack of hygiene.
Epidemiology
Diaper dermatitis affects infants in the first months of life. Most cases of diaper dermatitis are seen between nine and twelve months of age. Disposable diapers with high absorbency used today have greatly decreased the incidence of diaper dermatitis. Nevertheless, 2/3 of infants suffer from diaper dermatitis at least once and in about 25% this skin disease even occurs regularly. Since the protective function of the skin does not fully mature until after birth, the barrier function of the skin is much better developed in adults than in infants. Nevertheless, diaper dermatitis can also affect incontinent adults, but a precise differential diagnostic clarification is required. In children who were colonized with Candida fungi at birth, secondary Candida infections are frequently observed in association with diaper dermatitis.
Complications
- Frequent: relapses
- Superinfections caused by bacteria and fungi
- Extension to other areas of the body
- Impetigo (bacterial skin infection affecting mainly the face and extremities).
Risk factors
- Infancy
- Heat accumulation
- Moist, occlusive environment bad diapers
Diagnosis
Diagnosis is based on the clinical picture of the disease. A smear can also identify the causative agent of a superinfection associated with diaper dermatitis.
Differential diagnosis
Eczema of various causes:
- Intertrigo (may also be considered an early form of diaper dermatitis).
- Atopic dermatitis
- Seborrheic dermatitis
- Psoriasis (psoriasis)
- Perianal streptogenic dermatitis
- Contact dermatitis
- Scabies
- Other infections, such as those caused by herpes simplex or varicella.
- Mastocytosis (accumulation of mast cells in the skin).
- Genodermatoses (skin diseases that develop with the involvement of hereditary factors).
- Child abuse
When to see a doctor?
- If the skin lesions have not improved or even worsened after a few days.
- In case of severe bleeding of the skin.
- If there are frequent relapses. The child should be examined for the presence of underlying diseases that weaken the immune system.
Non-drug therapy
- Elimination of irritating factors that promote diaper dermatitis, such as dampness and friction.
- Diapers: Keep skin dry, so change diapers frequently or do not put on diapers. Use modern diapers that absorb well.
- Daily cleaning with a mild soap
- After washing, only gently pat dry, do not rub! The buttocks can also be dried with a hair dryer on a low setting.
Drug therapy
Antifungals: External:
- Clotrimazole
- Econazole
- Miconazole
- Nystatin
Internal:
- Amphotericin B
Clotrimazole, econazole, and miconazole may be used in children younger than 2 years only if prescribed by a physician. Antibiotics:
- Depending on the causative agent of the secondary bacterial infection.
- For Staphylococcus aureus infection: fusidic acid, oral cephalosporins, or beta-lactamase-resistant penicillins.
Anti-inflammatories: mild topical glucocorticoids:
- Hydrocortisone
- Clobetasone
- Flumetasone
Anti-infectives / antiseptics:
- Create barrier with zinc ointments
- Chlorhexidine
- Clioquinol
- Eosin
Alternative therapies:
- Pansy extract
- Chamomile extract has a disinfecting and anti-inflammatory effect
- Tannins; envelopes / bath e.g. with black tea: acts disinfectant, tanning, drying.
- Dyes such as gentian violet (pyoctanine solution): acts astringent, antifungal and antibacterial. Caution: only 1x per day andwenden, because too frequent use can lead to necrosis.
- Oak bark bath additive: has an anti-inflammatory effect.
- Dexpanthenol for the regeneration of the skin
- Mild skin wash emulsions: acts antibacterial, antifungal and sebum reducing (antiseborrheic).
Therapy notes:
- Strong sealing ointments or powder that clumps when wet must not be used, as they only aggravate the symptoms
- In fungal infections must not be used greasy ointments
- If possible, externally applicable medicines are used for the treatment of diaper dermatitis. In acute diaper dermatitis, hydrophilic pastes are particularly suitable because they are able to absorb moisture, for example, in the form of inflammatory secretions. However, systemic antifungal therapy is indicated in severe course of diaper dermatitis in combination with oral thrush or infestation of the gastrointestinal tract.
- Persistent bacterial infections must be treated systemically at best. In addition, topical antibiotics should be used only very cautiously because of the threat of resistance development.
Prevention
- Use of highly absorbent disposable diapers that are permeable to air.
- Letting the baby crawl around without diapers as often as possible
- Change diapers at least 6x per day
- If the diaper is full: change the child immediately, remove stool residue, wash the buttocks with warm water and possibly a mild syndet (synthetic detergent, which are gentler on the skin than soap) and then gently pat dry. However, since cleaning with soap and water is itself a strain on the skin and causes irritation, it should only be done when changing diapers after a bowel movement. Otherwise, cream-soaked wipes, zinc or almond oil should be used.
- Babies should be washed as gently as possible using mild soaps, so as not to compromise the protective function of the skin
- For the prophylaxis of diaper dermatitis are suitable, the skin from moisture protecting, lipophilic pastes.
- Low-sugar diet, which favorably affects the pH of the stool and urine. In addition, sugar is an ideal breeding ground for yeast fungi.
- Avoiding spicy and acidic foods, as they make the stool more aggressive.
- Cranberry juice can lower the pH of the urine
- Use of hypoallergenic infant formula
- Treatment of vaginal mycosis in pregnant women shortly before birth to prevent colonization of the newborn with Candida fungi.
Things to know
- The ammonia produced from urea attacks the skin and increases the irritating potential of stool many times over. Along the way, it causes an increase in pH and associated activation of fecal enzymes, such as proteases and lipases, which further increases irritation and inflammation.
- Significantly fewer cases of diaper dermatitis were recorded in breastfed infants.
