Diaper Dermatitis

Diaper dermatitis is inflammatory dermatitis affecting skin exposed to urine, stool, friction and prolonged moisture. Irritant contact dermatitis is the commonest form.

Candida superinfection is common when dermatitis persists, particularly after antibiotic exposure.

Irritant diaper dermatitis causes:

• Erythema over convex surfaces
• Scaling
• Superficial erosions
• Relative sparing of deep skin folds

Candida infection is suggested by:

• Beefy red plaques
• Involvement of skin folds
• Peripheral satellite papules or pustules

Severe erosions, ulceration, fever or rapidly spreading erythema should prompt assessment for bacterial infection or another dermatosis.

• Increase diaper changes and minimize prolonged contact with urine and stool.

• Clean gently with water or fragrance free wipes.

• Allow periods without a diaper where practical.

• Apply a thick barrier preparation such as zinc oxide or petrolatum at every diaper change.

• For significant inflammation, hydrocortisone 1% topical once or twice daily for a short course, usually 3 to 5 days, can be used.

• For candidal dermatitis, apply clotrimazole 1% cream twice daily for 7 to 14 days, continuing briefly after clinical resolution.

Avoid potent topical corticosteroids in the diaper area because occlusion increases absorption and risk of skin atrophy.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Uncomplicated Malaria In Children

Malaria is a mosquito borne protozoal infection caused by Plasmodium species. In Kenya, Plasmodium falciparum is the dominant cause of severe disease.

Young children in endemic areas are particularly vulnerable because protective immunity is incomplete.

Severe disease can evolve rapidly through cerebral involvement, hypoglycaemia, severe anaemia, metabolic acidosis and multiorgan dysfunction.

Confirm malaria with:

• Malaria rapid diagnostic test

• Microscopy using thick and thin blood films

Microscopy allows parasite detection, species identification and quantification.

A negative test should prompt active assessment for an alternative diagnosis.

When severe malaria remains strongly suspected despite an initial negative blood film, repeat high quality microscopy because parasitaemia can occasionally be initially missed.

Check:

• Bedside glucose
• Haemoglobin
• FBC
• Renal function
• Electrolytes
• Blood gas or lactate in severe disease

Do not attribute every fever in a malaria endemic setting to malaria merely because malaria exposure is common.

For uncomplicated confirmed falciparum malaria, give an appropriate artemisinin based combination therapy.

A commonly used first line regimen is artemether lumefantrine, given as 6 doses over 3 days according to weight band.

Ensure the child can tolerate oral medication.

Give fluids and feeding appropriately.

Treat fever and vomiting symptomatically.

Assess haemoglobin when anaemia is suspected.

Failure to improve requires reassessment for:

• Poor adherence
• Vomiting or inadequate absorption
• Severe malaria
• Alternative infection
• Antimalarial resistance
• Incorrect initial diagnosis

Any child developing severe features while receiving oral therapy should immediately be converted to parenteral severe malaria treatment.

Diaper Dermatitis

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management