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My baby got dat’ rash or is it Thrash?

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Presentation on theme: "My baby got dat’ rash or is it Thrash?"— Presentation transcript:

1 My baby got dat’ rash or is it Thrash?
Scott Carney

2 Diaper Dermatitis Prevalence
Represents 10 to 20 percent of all skin disorders evaluated by the general pediatrician Of those seen 1:4 is diagnosed with Diaper dermatitis From million outpatient visits

3 Epidemiology Peak frequency 9-12 months Risk Factors:
Poor hygiene (infrequent diaper changes) Past history of dermatitis Diarrhea Thrush Toilet training

4 Path to pain… Trifecta of factors that lead to dermatitis:
Increased skin hydration Chemical irritation Friction

5 A little’s good a lot’s mo’ betta
Increased hydration More liquid feces and urine leads to increased breakdown of stratum corneum Increases risk of frictional trauma, penetration of irritants and microbes

6 It’s the pee right? It’s gotta be the pee..
Study of 26 infants with diaper dermatitis found that high ammonia level on intact skin had no effect compared with those without dermatitis

7 But…. Fecal bacteria produce urease Degrades urine to ammonia
Increases stool pH Reactivates fecal enzymes protease and lipase Increases breakdown further of stratum corneum

8 Other risk factors Diet: Antibiotic usage:
Breast fed children have decreased incidence of DD likely due to a lower stool pH from Breast feeding Antibiotic usage: Patients with chronic antibiotic usage have increased risk of antibiotic associated diarrhea and increased risk of altered stool flora increasing risk for Candidal infection

9 Clinical features: Wide range of presentations
Asymptomatic erythema to painful scaling papules and superficial erosions Skin folds are spared Traditionally involves convex areas of diaper areas Including the buttocks, lower abdomen, genitalia, and upper thighs

10 Pretty straightforward right?
Not so fast, spectrum extends beyond classical diaper dermatitis to more severe forms including Tidewater dermatitis Jacquet's erosive dermatitis Granuloma gluteale infantum

11 Differential Dx: Allergic Contact Intertrigo Atopic Derm Seborrhea
Langerhan’s Psorias Child Abuse Zinc deficiency Biotin deficiency Herpes Scabies Candida Bacterial infection Syphillis

12 Tidewater/Lucky Luke/Diaper Dye Dermatitis
Erythema and scaling at the diaper margin due to friction and cycles of wetness and dryness Also thought to be due to rubber components of diaper

13 Tidewater Dermatits

14 Jacquet's erosive dermatitis
Well-demarcated papules, nodules, and punched-out ulcerations in the perineal region

15 Granuloma Gluteale Infantum
Reddish-purple nodules in the inguinal folds, scrotum, buttocks, and medial thighs Presents within 2-9 mo age Associated with use of steroid creams and chronic Candidal infections.

16 Oh Candida! Thought to have increased liklihood if it has persisted for > 3 days due to previously mentioned factors. Beefy red plaques, satellite papules, and superficial pustules Does not spare folds Typically associated with oral thrush (52%) In patients treated with abx for 10 days found to have 10x increased risk

17 Oh Candida!

18 Sebhorrea Salmon colored, well-demarcated scaling plaques especially in inguinal folds Greasy scaling lesions elsewhere Appears by 3-4 weeks resolves by 3-4 mo. Intertrigo Moist sharply demarcated erythema in folds with minimal scale No satellite lesions

19 Sebhorrea Intertrigo

20 Langerhan’s Hematologic/oncologic disorder
Present during infancy or early childhood Red/orange or yellow/brown scaly papules, erosions, or petechiae most commonly in the groin, intertriginous regions, and scalp

21 Langerhan’s

22 Zinc Deficiency Aka Acrodermatitis Enteropathica
Typical in breast fed patients that are not supplemeneted with vitamins Erythema, peeling of skin in multiple areas including hands, face, feet and nail changes

23 Zinc Deficiency

24 Management Education, Education, Education Prevention is key!
Frequent diaper changes Gentle cleansing, avoiding harsh soaps/frequent cleaning Barrier protection Antifungals/Anti-inflammatories

25 Wave of the future… Disposable diapers in place of cloth diapers have led to a decrease in incidence due to their super absorbant nature New diapers provide continuous administration of zinc oxide/petroleum to skin

26 Keep it clean… Removal of diaper as soon as it is soiled/wet to prevent interaction of enzymes Removal should be with a soft cloth and water to avoid removal of stool only and not barrier cream Avoid baby wipes that contain alcohol as they may increase drying out.

27 Barriers Work to prevent overhydration of skin
Reduces transepidermal loss of water and repels further water from entering skin. Disadvantages to using barriers are mostly due to the difficulty in removing them Ways to avoid: Use of mineral oil to soften paste Cornstarch instead of talcum powder to reduce frictional injury.

28 Barrier cream

29 Antifungals Indications: Satellite lesions Confirmation with KOH slide
Present for at least 3 days Nystatin, ketoconazole, miconazole all equally effective

30 Steroids Treatment limited to three to five days 2x daily and only to treat severely inflamed irritant diaper dermatitis due to increased absorbtion Only the lowest potency, nonhalogenated topical corticosteroids should be prescribed; over-the-counter 1% Hydrocortisone percent cream or ointment is often sufficient.

31 Antibiotics Topical only Only for secondarily infected.
Mild: Mupirocin 2x daily Avoid: Neosporin/Bacitracin due to increased allergic likelihood to neomycin

32 The End

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