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- Diaper dermatitis is a rash occurring under the covered area of a diaper. The rash may be a direct result of wearing the diaper, aggravated by the diaper, or coincidental with a rash that appears elsewhere on the body.
- System(s) affected: Skin/Exocrine
- Synonym(s): Diaper rash; Nappy rash
Incontinence is a significant cofactor.
- The most common dermatitis found in infancy
- Peak incidence: 7–12 months of age, then decreases
Prevalence has been variably reported from 4–35% in the first 2 years of life.
- Infrequent diaper changes
- Waterproof diapers
- Improper laundering (cloth diapers)
- Family history of dermatitis
- Hot, humid weather
- Recent treatment with oral antibiotics
- Diarrhea (>3 stools per day increases risk)
- Dye allergy
- Prior history of eczema may increase risk.
Attention to hygiene during bouts of diarrhea
- Fecal proteases and lipases are irritants.
- Superhydrase urease enzyme found in the stratum corneum liberates ammonia from cutaneous bacteria.
- Fecal lipase and protease activity is increased by acceleration of GI transit; thus, a higher incidence of irritant diaper dermatitis is observed in babies who have had diarrhea in the previous 48 hours.
- Once the skin is compromised, secondary infection by Candida albicans is common. 40–75% of diaper rashes that last >3 days are colonized with C. albicans.
- Bacteria may play a role in diaper dermatitis through reduction of fecal pH and resulting activation of enzymes.
- Allergy is exceedingly rare as a cause in infants.
- Wet skin from prolonged contact with urine or feces resulting in susceptibility to chemical, enzymatic, and physical injury; wet skin is also penetrated more easily.
- Some have raised the possibility of contact allergy from the dye in disposable diapers.
Commonly Associated Conditions
- Contact (allergic or irritant) dermatitis
- Seborrheic dermatitis
- Atopic dermatitis