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.

Diagnosis is clinical.

Investigations are rarely required.

Consider fungal microscopy or culture only in persistent or atypical disease.

• 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.