Epidemiology
Typically seen in infants
Etiology
Diaper-related
Irritant contact dermatitis (most common cause)
- Pathophysiology
- Caused by skin barrier breakdown from exposure to urine and stool trapped within the diaper.
- Patients with frequent stooling (eg, diarrhea) are at increased risk because urease produced by fecal bacteria causes an increase in local skin pH, which allows for activation of proteolytic enzymes that disrupt the stratum corneum.
- Areas of macerated skin are then prone to frictional damage from the diaper, which further exacerbates the rash.
- Clinical features
- Acute: pruritic and/or painful erythema, edema, and vesicular rash
- Chronic: pruritic and/or painful xerosis, scaling, lichenification, hyperkeratosis, and fissuring
- Well-defined borders
- Does not have skinfold involvement or satellite lesions
- Treatment
- Thick barrier ointment (eg, petrolatum) or paste (eg, zinc oxide), which provides the skin an adherent layer of protection from contact with the stool and urine
Allergic contact dermatitis
- Personal care products (e.g., perfumes, soaps, cosmetics)
- Intensely pruritic erythematous papules, vesicles with serous oozing
- Ill-defined borders
Candidiasis
- Scaly, erythematous, deep red plaques and satellite papules
