Diaper rash in children

In newborns and young children who wear diapers, the rash is common due to the constant occlusion of the skin under a diaper, exposure to the irritants, such as urine and faeces, and even the use of wet wipes, leading to overhydration and skin maceration.
As a result, the skin of this region easily becomes inflamed, which is manifested as redness, itching or burning, with cracks or abrasions. Bacterial or fungal infection (Candida albicans) can easily develop on damaged skin, contributing to the exacerbation of the clinical picture.

If a child has redness and rash in the diaper area, the following conditions should be considered:
* Candidiasis
* Irritant or contact dermatitis
* Seborrheic dermatitis

Candidiasis

Redness is observed in the genital area and on the skin folds, with or without erosions, small peripherical scales, as well as satellite blisters. The diagnosis is made based on mycological examination. Often, this condition is associated with the previous use of antibiotics. Treatment consists of the application of topical antifungals with frequent diaper changes, immediately after urination or defecation.
It is also recommended to occasionally remove the diaper and allow the skin to dry completely.

Irritant or contact dermatitis

Irritant/contact dermatitis develops as a result of prolonged skin contact with urine or faeces, or frequent use of wet wipes. It is characterized by redness with or without scales and small erosions. Occasionally verrucous papules can be observed. Lesions develop on convex surfaces and do not spread to the skin folds.
Treatment consists of corticosteroid creams and emollients, with adequate hygiene while avoiding the use of wet wipes.

Seborrheic dermatitis

Seborrheic dermatitis should be considered if the child has moist, bright reddish patches (salmon-coloured) with or without greasy-looking scales. The lesions are usually present on the groin, and can also be found on the head, face and other skin fold.
The therapy consists of the use of mild corticosteroid and imidazole creams, with frequent diaper changes. The use of emollients and skin cleansing with lukewarm water is also recommended.

Bacterial infections

Bullous impetigo is a superficial skin infection caused by Staphylococcus aureus bacterium. Initially, blisters develop on the skin, filled with clear liquid that becomes cloudy over time. After the blisters break out, bright erosions covered with yellowish crusts will remain. The infection is usually caused by bacteria in the nose or in other people who are in contact with the child. The infection spreads quickly and therefore adequate treatment with topical or systemic antibiotics is necessary.

Streptococcal perianal dermatitis is a common skin condition of the perianal region in children. The infection is caused by the bacterium Streptococcus pyogenes, leading to superficial inflammation of the skin manifested as clearly defined redness around the anus. If the inflammation has been present for a long time, painful cracks in the skin and scabs can develop. The lesions are accompanied by itching, pain or burning sensation, which can lead to defecation problems. In these children, streptococcal throat infection is present in about 50% of cases. The diagnosis is made based on microbiological examination of swabs taken from perianal region.
Topical and systemic antibiotics are prescribed according to the antibiogram.

Psoriasis

Psoriasis is less commonly seen as a cause of diaper rash. It is characterized by red plaques, with mild scales, which may be present on the skin folds and the other parts of the diaper region. The diagnosis of psoriasis is made based on psoriasiform lesions on other body parts, such as the scalp, face, palms and soles, or a positive family history.
The therapy is applied in accordance with the dermatologist’s recommendations. Usually corticosteroid creams, emollients, calcipotriol, topical retionoids or immunomodulators: pimecrolimus or tacrolimus are used.

Atopic dermatitis

In atopic dermatitis, redness, scratching marks and / or thickened skin are usually observed in the areas in direct contact with the diaper edges. The area around the genitals and the skin folds are usually spared. The lesions are accompanied by severe itching and dry skin. Eczematous lesions can be found in other body parts depending on the child’s age.
Emollient creams, oil baths, mild corticosteroids or calcineurin inhibitors are used in the treatment of this condition. In case of severe itching, sedative antihistamines should be used.

Allergic contact dermatitis

Allergic contact dermatitis – can be the cause of redness in the diaper region. The most common allergens are the substances found in diapers (such as sorbitan sesquioleate), fragrances, dyes, additives and preservatives found in wet wipes.
The most important thing in the treatment is to discover and eliminate the cause of allergic reaction. In addition to mild corticosteroid creams, it is recommended to use emollients and to change diapers regularly. Also, wet wipes should be avoided, it is better to wash the skin with lukewarm water or with hypoallergenic agents such as syndet.

Acrodermatitis enteropathica

Acrodermatitis enteropathica is a disorder associated with zinc deficiency.
Red lesions with blisters, moist, erosions and crusts develop on the skin around the mouth, eyes, anus and genitals These children also have other problems such as diarrhoea, hair loss, severe irritability and growth retardation.
The diagnosis is made by measuring the zinc level in the blood.
Therapy is prescribed by a dermatologist.

Langerhans cell histiocytosis

Langerhans cell histiocytosis is a rare systemic disorder. In the diaper region, behind the ears and on the head, yellowish-brown papules can be observed, merging into larger areas. This condition requires detailed examination and hospital treatment.

Diaper rash treatment

It is necessary that a dermatologist makes a proper diagnosis, with a bacteriological swab analysis. Even if bacterial are not the cause of the diaper rash, they can easily be found in that region due to skin irritation and interfere with treatment.
Antibacterial drugs, antifungal drugs, corticosteroids, immunomodulators are used in the treatment, and, above all, proper hygiene is mandatory.


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