DERM- diaper dermatitis

Question 1

irritant derm

Answer 1

most common, associated with diaper use

occurs on contact surface where diaper touches

red, scalling plaques with erosions

CREASES ARE SPARED, NO LESIONS

when not treated for more than 3 days, may becoem infected with organisms like candidia

Question 2

candidal diaper derm

Answer 2

usually involves SKIN CREASES

classic presentation- beefy red plaques with satellite papules

after rupture, superficial pustules leave a scale

usually have h/o diarrhea prior to rash, atb use or oral thrush- look at mouth

Question 3

Allergic dermititis

Answer 3

reaction to allergens in diaper

dyes/abs poperties/

WELL DEMARCATED redness also with papules, scale, vessicles or errosion in diaper area

Question 4

topical combo antifungals with glucocorticoid such as mycolog, lotrisone

Answer 4

are NOT used in diaper area

too potent for skin, s/e or glucocorticoid- skin atrophy, adrenal supression

Question 5

Treatment irritant derm

most effective method

Answer 5

eliminate direct skin contact with urine/feces

diaper free time, freq diaper changes

Question 6

Topical barriers - irritant diaper derm

Answer 6

first line therapy for treating and prevention

apply thickly at every diaper change and cover with vaseline to keep from sticking to diaper

physically block chemical irritants and keep moisture form contact and also minimize friction

Question 7

what barriers are better?

Answer 7

pastes/ointments better than creams/lotions

Most OTC contain petr, zinc or both

Desitin, triple paste, A&D, Dr smiths, blamex

(min adherance, min occlusions, contain preservatives)

Question 8

powders?

Answer 8

if contain cornstarch or talcum

should be avoided- sig resp risk if aspirated

Question 9

Indications for antifungals

Answer 9

if determined candidal, wait 3 days, not given day 1 of diaper rash

applied to diaper area beneath barrier ointment 2-3x/day until resolved

Question 10

Antifungals

Answer 10

nystatin (mycostatin)

clotrimazole (lotrimin)

Question 11

topical atb first choice

Answer 11

Bactroban for mild infection

if staff treatment persists 10-14 days

Question 12

oral atb

Answer 12

for moderate/severe infections

Augmentin or Keflex

Question 13

young child appearing ill

Answer 13

or febrile- eval for serious bacterial illness and may require hospitalization for IV atb

Question 14

neosporin

bacetracin

Answer 14

aviod in diaper area, neosporin contains neomycin commonly cause od allergen for allergic dermatitis

aviod bacetracin for same reason

Question 15

prevention of diaper derm

Answer 15

eliminate contact

diaper selection

hygiene- mild soap, if eroded just irrigate with warm water

baby wipes-avoid, use conservitvely after healed

diaper-free time