Persistent Diaper Rash in a 5-month-old Girl

Joana Matos; João Tavares; Susana Machado; Manuela Selores

doi:10.1542/pir.2018-0141

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Joana Matos, MD*
João Tavares, MD†
Susana Machado, MD‡
Manuela Selores, MD‡

^*Serviço de Pediatria do Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
^†Hospital Pediátrico, Centro Hospitalar da Universidade de Coimbra, Coimbra, Portugal
^‡Serviço de Dermatologia do Centro Hospitalar do Porto, Porto, Portugal

AUTHOR DISCLOSURE
Drs Matos, Tavares, Machado, and Selores have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 5-month-old girl is referred to pediatric dermatology for a diaper rash persisting for more than 2 months despite antifungal treatment and several barrier creams. She is otherwise asymptomatic and has no relevant medical history. The family history is significant for her father with episodic erythematous lesions over the forearms and legs.

Physical examination reveals a well-defined, bright, erythematous plaque affecting the perineal area, including the groins and upper thigh, with minimal peripheral scaling (Fig 1). She also has 2 smaller satellite lesions in the left thigh. There are no other abnormal findings on physical examination. The clinical features and family history suggest the diagnosis.

Figure 1.

Erythematous plaque in the diaper area at presentation.

Diagnosis

Many dermatoses affect the diaper region, including the most common irritant, contact dermatitis. More diffuse skin diseases and systemic disorders that can manifest with specific diaper region symptoms may include inflammatory dermatoses such as seborrheic dermatitis or psoriasis, infections (eg, Candida albicans infection, perianal streptococcal and staphylococcal dermatitis), and metabolic disorders such as acrodermatitis enteropathica or neoplasia (eg, Langerhans cell histiocytosis). Immersion burns resulting from either inadvertent or intentional immersion in hot water or other liquid may also appear with a well-delimited erythematous diaper area rash.

Based on the clinical features and suggestive family history, the patient was diagnosed as having psoriasis and was prescribed an antifungal and corticosteroid combination cream plus a zinc oxide–based repair ointment.