12 - Diaper Rash Flashcards
What is a Diaper Rash?
Acute inflammatory rxn
in the area of skin covered by a diaper
MOST common in infants 9-12 months
Can also occur in adults w/ diapers
for continence issues
SAME as infants
What CAUSES diaper rash?
Increased PERMEABILITY
skin hydration / increased pH / fecal enzymes / microorganisms
- *Compromised Skin -> Diaper Dermatitis**
- *chemical irritants** / fecal enzymes / mechanical irritation
- *C. albicans infection**
How to PREVENT/Treat Diaper rash
INCREASE diaper changes
INCREASE Bath frequency
Medication + Protectants
Risk Factors for DIAPER RASH in infants
+ Complications
Bottle fed (vs breast fed)
Introduction of Solid Foods
CLOTH diapers
Oral Antibiotics
related to risk of diarrhea + secondary infection w/ yeast
Complications
Bacterial overgrowth = Staph/strep –> pustules w/ crusting
Fungal infection = C.Albicans –> RED / satellite lesions
EX-ST
for Diaper Rash
Lesions on body OUTSIDE diaper area
>7 days or no improvement after 3-4days treatment
Physiological changes = NVD + Fever
constitutional symptoms = lethargy / behavior changes
BROKEN SKIN
Ulceration / blistering / peeling
- *SECONDARY infection**
- *pus / oozing lesions / satellite lesions**
- *Comorbid Condition**
- *HIV / organ transplant / immunosupression**
NON-Pharmacologic Management
of Diaper Rash
Remove source of irritation
“Diaper-Free” time
Frequent Change = >6 times / day
Thoroughly CLEAN + DRY the diaper area after each change
Proper diaper use:
disposables / properly-laundered cloth diapers
PROTECTANTS
Pharmacologic Management of Diaper Rash
Various Products + MoA
DECREASE Skin Friction
Non-Powders = protect from contact w/ moisture
Powders = absorb moisture
Allantoin / Calamine / Cocoa Butter / Cod liver oil
Colloidal Oatmeal / Dimethicone / Glycerin / hard fat
Kaolin / Lanolin / Mineral Oil / Petrolatum
Topical CORNSTARCH
Zinc Acetate/Carbonate/oxide
TALC = acceptable ingredient but is consiered a COSMETIC agent
- *PROTECTANTS**
- *instructions for use**
Pharmacologic Management of Diaper Rash
AAA or Area @ Risk
with EVERY diaper change
are should be CLEAN + DRY
BEFORE application
Protectants
Caution + ADR
Pharmacologic Management of Diaper Rash
Generally considered safe, no OD risk
Hydrophobic may be difficult to REMOVE from skin
Powders should be kept away from FACE
inhalation issue
TALC = should NOT be used on broken/oozing skin
Lanolin may cause contact dermatitis
Agents to AVOID
Pharmacologic Management of Diaper Rash
- *Topical Analgesics**
- *CAMPHOR**
- *Antiseptics**
- *Boric Acid** / Benzalkonium Chloride / Calcium undecyclenate
- *AntiMicrobials + AntiFungals**
- unless recommended by MD*
Topical Anti-Inflammatories
Corticosteroids, unless recommended by MD = use LOW potency
Selecting a PRODUCT
Agents for diaper rash
there are NO contraindicated combinations
many products have >1 apporoved protectants
Review inactive ingredients
to ensure NO undesireble agents
Select agent with LEAST inactive ingredients
Comparable products, let caregiver have preference
PHARMacologic Management of
INFECTED Diaper Rash
After DIAGNOSIS of 2ndary fungal infection
Treat w/ OTC antifungal agent:
Miconazole / Clotrimazole
clean / DRY affected area
Apply antifungal to AA BID-TID
do NOT apply with EVERY diaper change!
Apply protectant for interim diaper changes
What OTC medication can be used if
2ndary Fungal Infection was DIAGNOSED by MD?
LOTRIMIN AF
Miconazole or Clotrimazole
Comes in creams / powders / sprays
PREVENTION of Diaper Rash
Proper Diaper Hygiene = KEY
Frequent change / avoid plastic pants
completely CLEAN + DRY diaper area
Recommend use of Protectants PREVENTITIVELY when
@risk of diaper rash = Antibiotic use / Diarrhea
can be PREVENTED w/ appropriate us
do NOT use antifungals PREVENTATIVELY
Desitin
PROTECTANT for Diaper Rash
ZINC OXIDE
Paste / Cream / Ointment (petrolatum)
also good for PREVENTION of diaper rash
most important is proper diaper hygiene / changing
See MD if >7days
