Diaper Dermatitis

Diaper dermatitis, commonly referred to as diaper rash, is a frequent diagnosis in the pediatric setting, causing distress in both infants and parents because of its often persistent nature despite diligent care around diaper changes. Although diaper dermatitis can be seen in any patient wearing diapers, it typically peaks between 9 and 12 months. Many underlying etiologies should be considered when evaluating a patient with diaper dermatitis. A thorough evaluation involves the patient’s underlying medical and family history, characterization of the rash distribution and morphology, and any contributing factors, such as topical products, foods, or other exposures.

The most common cause of diaper dermatitis is irritant contact dermatitis. In irritant diaper dermatitis the integrity and barrier function of the skin is compromised by 2 major factors: increased moisture caused by the occlusive environment of the diaper combined with urine and fecal waste and a higher pH environment due to increases in protease and lipase activity. The dermatologic findings include erythema, papules, and scaling of the skin in direct contact with the diaper, including the convex skin areas: the buttocks, inner thighs, and genitalia. The goal of treatment of irritant dermatitis is to create conditions that allow diapered skin to maintain its physiologic pH and limit exposure to irritants that promote skin breakdown as much as possible.

There are a variety of approaches to achieve this goal, but the straightforward mnemonic of ABCDE (air, barrier, cleansing, diaper, and education) may be easiest to recall and explain to families.

• A: Air time, or being diaper free, can be challenging for families to incorporate into their daily routine for extended periods. However, open air time is one of the most economical, safe, and efficacious treatments for diaper dermatitis. It increases air circulation and drying of the area while decreasing friction from the diaper …