DIAPER RASH

Presented by :

Riska 110 203 026Wa Ode Nur Rahmaniar 110 203 168

Advisor : dr. Shinta J. B Toban RambuSupervisor : dr. Khaeruddin Djawad, Sp.KK

INTRODUCTIONDiaper Rash is a generalized term

indicating any skin irritation that develops in the diaper-covered region.

Synonims include diaper dermatitis, napkin (or “nappy”) dermatitis and ammonia dermatitis.

EPIDEMIOLOGYDiaper rash is the most common

dermatitis found in infancy.No sexual predilection exists.Diaper rashes can start in the neonatal

period as soon as the child begins to wear diaper.

The insidens peaks in those aged 7-12 months, then decreases with age.

ETIOLOGIDiaper Rash can be traced to a number of causes, including: Friction Irritation from stool and urine Introduction of new foods Bacterial or fungi infection Sensitive skin Use of antibiotics

PATHOGENESISThe wearing of diapers causes a significant increase in skin witness and pH. Prolonged wetness leads to maceration of the stratum korneum, the outer, protective layer of the skin, which is associated with extensive discruption of intercellular lipid lamellae.

PATHOGENESIS

Weakening of its physical integrity makes the stratum corneum more susceptible to damage by:1.Friction from the surface of the diaper2.Local irritants

CLINICAL FEATURE

The most common for of primary irritant napkin dermatitis comprises confluent erythema of the convex surfaces in closest contact with the napkin, i.e the buttocks, the genitalia, the lower abdomen and pubic area, and the upper thighs.

CLINICAL FEATURE

CLINICAL FEATURE

Occasionally, an erosive form of primary irritant napkin dermatitis is seen, in which small vesicles and erosions may develop into rather characteristic shallow round ulcers with raised crater-like edges (‘Jacquet’s dermatitis’)

ADDITIONAL EXAMINATION1. Laboratory Studies The primary form of diaper rash

generally can be diagnosed clinically. A complete blood count may be helpful,

especially if a fever is present and a secondary bacterial infection is suspected.

ADDITIONAL EXAMINATION

2. Histological PictureGenerally that of primary irritant dermatitis

with epidermal spongiosis and mild inflammatory changes in the dermis

ADDITIONAL EXAMINATION

3. Other TestsKOH scrapings from a fresh papular or

pustular lesion in suspected cases of candidiasis.

DIAGNOSIS

The presence of skin lesions in the diaper area means that the baby has diaper rash.

DIFFERENTIAL DIAGNOSIS

Neonatal CandidiasisA moist, erosive, pruritic patch of the perianal skin and perineum (with satellite pustule formation)

DIFFERENTIAL DIAGNOSIS

Congenital SyphilisReddish-brown macules, sometimes slightly raised. Bullous or erosive lesions may occur in the napkin area.

DIFFERENTIAL DIAGNOSIS

Zinc Deficiency :Infant with napkin

eruptions caused by zinc deficiency usually have a concurrent facialis dermatitis.

TREATMENT

Corticostertoid, topical : Hydrocortisone, apply a thin film topically

to rash qid for 14 daysAntifugal agents :

Nystatin, oral thrush : 4-6mL p.o, swish and swallow qid. Clotrimazole, miconazole, ketokonazole, apply topically to rash at every diaper change until resolved.

TREATMENTAntibiotics, topical:

Bacitracin, apply topically to rash at every diaper change until resolved.

Antibiotics, oralAmoxicillin and clavulanate, <3 months : 125 mg/5mL p.o divided bid for 7-10 days>3 months :45mg/kg/day p.o divided 12 hours.

COMPLICATIONSkin ulceration and secondary infection

by Candida albicans or bacteria Jacquet dermatitisGranuloma gluteale infantum

PROGNOSISMost cases completely resolve after a

concerted effort by parents toward diaper hygiene

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