Dermatitis, Diaper

SOURCE

Source: Law RM, Law DTS. Dermatologic drug reactions and common skin conditions. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146079670. Accessed May 10, 2017.

CONDITION/DISORDER SYNONYM

• Diaper rash.

DEFINITION

• Acute, inflammatory contact dermatitis of buttocks, genitalia, perineal regions, lower abdomen, or thigh folds of infant or toddler resulting from direct fecal and moisture contact with skin in occlusive environment.

CLINICAL PRESENTATION

SIGNS AND SYMPTOMS

• Erythematous rash; vesicles and oozing erosions may be present in severe cases.

• May be infected by Candida species and present with confluent red plaques, papules, and pustules.

DIAGNOSIS

• Based on clinical presentation.

DESIRED OUTCOMES

• Relieve symptoms.

• Remove precipitating factors.

• Prevent recurrences.

• Avoid adverse treatment effects.

• Improve quality of life.

TREATMENT: NONPHARMACOLOGIC THERAPY

• Frequent diaper changes.

• Air drying (remove diaper for as long as practical)

• Gentle cleansing with nonsoap cleansers and lukewarm water.

TREATMENT: PHARMACOLOGIC THERAPY

• May apply zinc oxide for astringent and absorbent properties and to provide effective moisture barrier.

• Apply topical imidazole antifungal agents for Candida (yeast). Discontinue therapy when rash subsides and continue barrier product to prevent recurrence.

• May use very low potency topical corticosteroid (hydrocortisone 0.5–1%) for short periods (1–2 weeks) in severe inflammatory cases.

• Commercial diaper wipes containing fragrance or alcohol should be avoided.

MONITORING

• Educate caregivers on causative factors, preventive measures, and useful treatments.

• Evaluate patients periodically to assess efficacy of therapy and possible side effects.

Date Written: May 10, 2017

Contributor: Lauren Roller, PharmD, BCCCP

Editor: Lauren Roller, PharmD, BCCCP; Laura Baumgartner, PharmD, BCPS, BCCCP