Diaper Dematitis Flashcards
who is affected by diaper dermatitis
aka diaper rash or incontinence associated derm
30% of the infant population
peak incidence around 9-12 months
- exsists aas contact derm -> branches into allergic or irritant
describe the pathophysiology of diaper dermatitis
microbes and urea (conv to ammonia) from urine + fecal enzymes & bile salts from feces + occulsion from diapers leads to inc moisture and overhydration and inc pH
- leads to inc risk of infection and sensitivity to irritants
PLUS
phyiscal irritation from freq cleanging and mechanical friction and chmiecal irritation leads to dmages skin with increase permeability and dec barrier function
both togeth cause diaper derm
clinicla presentation and location of diaper derm (irritant allergic and candidal)
- Appearance
- irritatant: mild erythema -> shiny patches w/ deep drythema -? papules, vesiles and ulcers
- allergic: grouped or linear tense vesicles and blisters, marked edema in severe cases
- Candidal: beefy red plaques with satellit epustules and early maceration of skin
- Location
- irritant: convex surfaces
- Allergic: generally limited to areas in contact with allergen
- candidal: almsot always involved inhuinal folds
what are the risk/aggrevating factors of diaper derm
- patient related
- age (infant and older adults)
- diet
- comorbid skin conditions
- Fiaper related
- infrequeny changes, inadequate rinsing of cloth diapers
- use of plastic coverse
- Chemica/drug related
- fragrence, boric acid volatile alc, surfactants
- medications that inc GI motility, affect autonomic control of uriantion/defication or alter GI flora
- Fricaiton related
- fre, vigorous cleaning & rubbing; immobilizaiton
what can diaber rahs be mistaken for
- Acrodermatitis enteropathica
Bullous impetigo
Langerhans cell histiocytosis
Pressure injury
Psoriasis
what are the red flags for diaper dermatitis
- Acute onset with pus, vesicles, or ulceration
- Frequent recurrences
- Moderate or severe presentation
- Rash or skin lesions outside the diaper area
- Complicated secondary infection or comorbid UTI
- Significant behavioural changes
- Signs of abuse or neglec
t • Patient is immunocompromised
• Fails to improve despite 7 days of appropriate tx, or fails to resolve after 14 days
what are the goals of thearpy for diaper rash
1) Relieve symptoms
2) Resolve dermatitis
3) Prevent complications
4) Prevent recurrences
what are the non pharm strategies to treat diaper derm
ABCDE
- Air
- encourage air drying
- avoid particles that can cause chapping or burnd
- use incontinence products w/ aborsent cores and breathable covers
- Barries
- apply thin barrier product with each diabet change
- avoid powders (or only use with extreme caution)
- Cleansing and compressing
- genlty celar area after urination and defication
- avoid voer cleaning
- if oozing & crusting qith acute inflammation, compressing with wet dressings may be reocmmneded
- Diapers
- change Q3-4h and whenever there is wetness or BM
- never use apparently unsoils part of diaper to wipe area
- wash cloth diapers in mild detergent
- Education:
- educate patients and caregivers of prevention and treatment of DD
what is the general approach to treating diaper derm
- Ensure adherence to ABCDE and change protectand barrier to zinc oxide 20-40%
- If ineffective
- if DD predominately inflamatory in nature
- if yes ass hydrocortisone 0.5-1%
- is Candida infection suspected?
- if yes add a topical antifungal, and if inflammation present add hydrocortisone
- if DD predominately inflamatory in nature
follow up for diaper derm
- follow up in 7 days
- fi resolved -> discontinue tx and cont ABCDEs
- if improved but not resolves-> cont tx for another 7 days
- if worsened or no improvemend -> refer
what options are available for prevention of diaper derm
*these are only barrier products
- Ceramide-based, petrolatum and silicone base
- apply generously PRN
- skin protection is immediate and lasts 3h
characteristics fo ceraminde based cream and adverse effects
* only a barrier product
- Characterisitcs
- inc ceramide:cholesterol ratio
- does not abs excess mositure
- has not been compared to other barriers
- Adverse effects
- mild burnign or stinging lasting 10-15 min
characteristics of petrolatum and adverse effects
* only a barrier product
- Characterisitcs
- mineral derived
- no capacity to abs water
- widely recommended and anecdotally effective but evidence is lacking
- Adverse effects
- can be irritating to inflamed skin
- traps mosture on the skin surface and may lead to maceration
characterisitcs of silicone based products for diaper derm
* only a barrier product
- Characterisitcs
- water repellent only
- soothe by protecting agaisnt irritants
- Adverse effects
- non irritating
- formulations that contain additives (lanolin, preservatives, fragrences) may be sensitizing
what treatment is available for treatment and prevention of diaper derm
zinc oxide
apply genreously PRN
skin proection is immediate and lasts 3h
- non irritating, formuations that contain additives may be sensisitiving
also ahs astringent and antiseptic properies
- effective for prevetnion at lower conc (10-20%) and treatment at hgiher conc (>20%)
- may need to spread gently with a tongue depressor or spatula and remove with mineral oil
