Diaper Rash

Question 1

What are some characteristics of diaper rash?

Answer 1

irritant contact dermatitis
skin folds are typically spared
self-limiting (episodes last 2-3 days)

Question 2

What are the causes or risks for diaper rash?

Answer 2

fecal/urine contact (viral gastroenteritis releases harsh enzymes)
chemical residue
chafing
antibiotic use (diarrhea as the side effect)
formula more problematic than breast milk
daycares

Question 3

What type of stool is most caustic of diaper rash?

Answer 3

type 7=entirely liquid
more watery is harsher on the diaper area

Question 4

When do we have to worry about chemical residue causing diaper rash?

Answer 4

the baby wears cloth diapers

Question 5

What are some other conditions to keep in your differential diagnosis when a parent says their kid has diaper rash?

Answer 5

eczema (often spares groin region, multiple locations)
seborrheic dermatitis (mostly in skin folds, yellow scales)
impetigo

Question 6

How can you try prevent a diaper rash?

Answer 6

change diapers as soon as possible
keep area clean
barrier products

Question 7

Why was talcum powder banned?

Answer 7

it was getting in the lungs of babies
probably fine for diaper rash, ppl just didnt use it right

Question 8

What is it good way to know if diaper rash is infected?

Answer 8

<3 days: probably just diaper rash with no infection
>3 days: probably yeast infection (C.albicans)

Question 9

What are some signs of yeast infected diaper rash?

Answer 9

fiery red
vesicles/satellites
skin folds now involved

Question 10

How do we treat uninfected diaper rash?

Answer 10

keep clean
barrier cream
can use a steroid, not necessary

Question 11

How do we treat yeast infected diaper rash?

Answer 11

keep clean
antifungal
barrier cream
can use a steroid, not necessary

Question 12

What is infant oral thrush?

Answer 12

yeast infection of the mouth

Question 13

What can you assume if a child has oral thrush as well as diaper rash?

Answer 13

assume the diaper rash is infected with yeast

Question 14

What agents are used OTC to treat yeast infected diaper rash?

Answer 14

clotrimazole 1% (Canesten foot or vaginal)
miconazole 2% (Monistat vaginal or Micatin foot)

Question 15

If we are out of clotrimazole foot-version, and we only have the vaginal version, which one should we go for in yeast infected diaper rash?

Answer 15

1% (6 day treatment)
-external vag cream, not the one with applicators

Question 16

How long is an OTC treatment for yeast infected diaper rash?

Answer 16

apply miconazole 2% or clotrimazole 1% BID for 1 week and one week after clearing

Question 17

Which agents can be prescribed for yeast infected diaper rash? Is a prescription necessary?

Answer 17

ketoconazole or ciclopirox
no need, the OTC azoles are just as good

Question 18

Which steroid should you pick for diaper rash? How long will it be used?

Answer 18

0.5% or 1% hydrocortisone
2-3 days (the azole is used for 14 days, thus combo products are undesirable)

Question 19

When should topical antifungals be considered for diaper rash?

Answer 19

skin irritation present for more than 3 days

Question 20

If using multiple products for diaper rash, what is the order of application?

Answer 20

anti-fungal>hydrocortisone>barrier product
2-3 minutes between application

Question 21

How many times and for how long do you apply steroids and barriers creams to uninfected diaper rash?

Answer 21

steroid: BID for 1-2 days
barrier cream: 4-5x per day everyday
steroid is optional

Question 22

How many times and for how long do you apply steroids, antifungal, and barriers creams for infected diaper rash?

Answer 22

antifungal: BID for 14 days
steroid: BID for 1-2 days
barrier cream: 4-5x per day everyday
steroid is optional

Question 23

True or false: hydrocortisone 1% does not require a prescription for a child younger than 2

Answer 23

false

Question 24

What can pharmacists prescribe for diaper rash?

Answer 24

hydrocortisone 1% if younger than 2
ketoconazole 2% (BID x 14 days)

Question 25

When do we refer for diaper rash?

Answer 25

rash fails to improve after 7 days or resolve after 14 days