What are the other Names for this Condition? (Also known as/Synonyms)

• Diaper Rash
• Irritant Diaper Dermatitis
• Napkin Dermatitis

What is Diaper Dermatitis? (Definition/Background Information)

• Diaper Dermatitis is described as a form of irritant contact dermatitis that affects individuals using diapers (mostly babies and elderly adults), at the area of skin contact. The condition is also known as Napkin Dermatitis or Diaper Rash
• Irritant contact dermatitis is a medical disorder in which the skin gets damaged and inflamed due to exposure to chemicals or substances that irritate the outer protective layer of skin
• Diaper Dermatitis is most often associated with reused cloth napkins or poor-quality diapers, in many rural and poorer world regions. It is important to note that the modern multi-layered disposable diapers are less prone to causing such skin rashes
• Elderly adults, who use adult diapers for urinary/fecal incontinence, since they are bedridden for long durations or have certain mental disorders, such as Alzheimer’s disease, are also more susceptible to Diaper Dermatitis
• The cause of Diaper Dermatitis involves a combination of multiple factors such as constant wetness in the region, rubbing/friction between the skin and diaper material, presence of urine or feces, and microorganisms that are present in the environment (vicinity)
• Some of the signs and symptoms of Diaper Dermatitis include red skin rashes on the buttocks, groin, and upper thighs, which may ulcerate and bleed. This can eventually result in a bacterial or fungal infection
• The treatment of Diaper Dermatitis involves limiting the use of diapers (where possible), using better quality diapers, topical creams and lotions, and medications for bacterial or fungal infections. In general, the prognosis is good with appropriate treatment. However, the condition may recur, especially in older adults

Who gets Diaper Dermatitis? (Age and Sex Distribution)

• Diaper Dermatitis is typically seen in babies in the 3-18 months age range and the elderly adults (the infirm). However, individuals of any age using diapers may be at risk for Diaper Rash
• Both men and women are affected by this condition
• No racial, ethnic, or geographical predominance is observed

What are the Risk Factors for Diaper Dermatitis? (Predisposing Factors)

The primary risk factor for Diaper Dermatitis is the use of diapers constantly for prolonged periods. However, having certain underlying skin conditions can elevate one’s risk for Diaper Dermatitis. These conditions include:

• Atopic eczema
• Candidiasis
• Impetigo
• Miliaria
• Psoriasis
• Seborrheic dermatitis

Elderly adults who are bedridden, have certain neurological conditions, such as Alzheimer’s disease or Parkinson’s disease, and/or having urinary and/or bowel incontinence, are highly vulnerable to Diaper Dermatitis.

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diaper Dermatitis? (Etiology)

Diaper Dermatitis is a type of irritant contact dermatitis. The condition occurs when the skin gets damaged due to exposure to substances that irritate the outer protective layer of the skin. Diaper Dermatitis is not an allergic condition and is not caused due to toxic reaction between urine/feces and diaper materials, but is due to a combination of several factors such as:

• Trapped urine and feces that combine to increase the pH value, which may be speeded up or aggravated by diarrhea or increased urination
• Blockage of skin pores by urine or sweat (wetness)
• Prolonged mechanical friction due to rubbing of the diaper material on skin, or due to wearing tight diapers
• The outermost protective layer of skin gets softened or eroded (maceration), which leads to deeper skin layers being affected
• Presence of microorganisms that grow and thrive in the region: The involvement of Candida albicans is noted in about 60-80% of the cases; and, Staphylococcus aureus in a majority of cases

Having any other underlying skin condition (such as psoriasis, atopic eczema, or seborrheic dermatitis) may increase one’s susceptibility for Diaper Rash.

What are the Signs and Symptoms of Diaper Dermatitis?

The signs and symptoms of Diaper Dermatitis can be mild or severe and may include:

• The skin area involved is mostly the outward curved surfaces of the pelvic region and upper thighs that maintain constant contact with the diaper; the folds usually do not present any rashes
• The rashes are red (erythematous) and its layout may take the outline of the diaper
• Erosion and ulceration of the skin surface is generally noted
• Smaller satellite rashes may be seen on the border of the large rashes
• Rarely, the lesions may be wart-like or nodular in appearance
• Pain, burning sensation, and tenderness in the affected area
• Constant irritation and crying in infants
• If a secondary infection develops, such as bacterial or fungal infection, the area of involvement may spread to the non-contact areas too

How is Diaper Dermatitis Diagnosed?

A diagnosis of Diaper Dermatitis would include:

• A complete evaluation of one’s medical history and a thorough physical examination to observe the signs and symptoms
• Culture studies through skin swabs to detect any bacterial or fungal infection

Note: A skin tissue biopsy is usually not necessary for a diagnosis of Diaper Dermatitis; however, it can be performed to eliminate other skin conditions.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diaper Dermatitis?

Diaper Dermatitis could lead to the following complications namely:

• Bacterial and fungal infection: Continuous itching and scaling of the skin will create skin moistness, providing a suitable environment for bacteria and fungi to grow and thrive
• Increased risk for urinary tract infection in women and young children including in infants
• Chronic conditions may cause emotional stress
• Recurrence of the condition

How is Diaper Dermatitis Treated?

Diaper Dermatitis may be managed through the following measures:

• Diaper-related:
  • Minimizing the use of diapers, as much as is practically possible
  • Frequently changing diapers; keeping the pelvic region ‘diaper-free’ for certain periods of time
  • Washing and cleaning the pelvic region; and then, keeping it dry and adequately ventilated
  • Use of good quality disposable diapers; breathable diapers that are hypoallergenic and superabsorbent
• Use of topical applications and barrier creams; petroleum jelly and creams containing zinc oxide
• Use of mild topical steroidal creams
• Administration of antifungal or antibiotic medication, if required
• In case of severe symptoms, systemic therapy may be necessary
• Undertaking treatment of any other skin conditions

A few self-care tips and home remedies may include:

• Avoid scratching the affected area
• Clean the baby with warm water and dry with a soft cloth
• Keep the area open and well-ventilated, where possible
• Wearing smooth cotton clothes

How can Diaper Dermatitis be Prevented?

The following measures may be adopted to avoid the risk of Diaper Dermatitis:

• Breastfed babies: The incidence of the condition is lower in babies who are solely breastfed than those who begin to eat solid foods in addition to breastmilk, due to comparatively lower pH value of urine
• Minimizing the use of diapers/nappies
• Undertaking steps to control incontinence in the elderly adults
• Treat any underlying skin conditions promptly in individuals with a high-risk for Diaper Dermatitis

What is the Prognosis of Diaper Dermatitis? (Outcomes/Resolutions)

• Diaper Dermatitis usually resolves within a short duration of time, without any complications, especially in babies and infants
• In elderly adults with underlying health conditions that predispose them to wearing diapers, the prognosis depends upon several factors. However, with adequate care and treatment, the prognosis can be good

Additional and Relevant Useful Information for Diaper Dermatitis:

The following article link will help you understand contact dermatitis:

http://www.dovemed.com/diseases-conditions/contact-dermatitis/