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 pediatricianOf those seen 1:4 is diagnosed with Diaper dermatitisFrom million outpatient visits
3 Epidemiology Peak frequency 9-12 months Risk Factors: Poor hygiene (infrequent diaper changes)Past history of dermatitisDiarrheaThrushToilet training
4 Path to pain… Trifecta of factors that lead to dermatitis: Increased skin hydrationChemical irritationFriction
5 A little’s good a lot’s mo’ betta Increased hydrationMore liquid feces and urine leads to increased breakdown of stratum corneumIncreases 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 pHReactivates fecal enzymes protease and lipaseIncreases 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 feedingAntibiotic 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 erosionsSkin folds are sparedTraditionally involves convex areas of diaper areasIncluding 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 includingTidewater dermatitisJacquet's erosive dermatitisGranuloma gluteale infantum
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 thighsPresents within 2-9 mo ageAssociated 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 pustulesDoes not spare foldsTypically associated with oral thrush (52%)In patients treated with abx for 10 days found to have 10x increased risk
18 SebhorreaSalmon colored, well-demarcated scaling plaques especially in inguinal foldsGreasy scaling lesions elsewhereAppears by 3-4 weeks resolves by 3-4 mo.IntertrigoMoist sharply demarcated erythema in folds with minimal scaleNo satellite lesions
20 Langerhan’s Hematologic/oncologic disorder Present during infancy or early childhoodRed/orange or yellow/brown scaly papules, erosions, or petechiae most commonly in the groin, intertriginous regions, and scalp
22 Zinc Deficiency Aka Acrodermatitis Enteropathica Typical in breast fed patients that are not supplemeneted with vitaminsErythema, peeling of skin in multiple areas including hands, face, feet and nail changes
25 Wave of the future…Disposable diapers in place of cloth diapers have led to a decrease in incidence due to their super absorbant natureNew 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 enzymesRemoval should be with a soft cloth and water to avoid removal of stool only and not barrier creamAvoid 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 themWays to avoid:Use of mineral oil to soften pasteCornstarch instead of talcum powder to reduce frictional injury.
29 Antifungals Indications: Satellite lesions Confirmation with KOH slide Present for at least 3 daysNystatin, ketoconazole, miconazole all equally effective
30 SteroidsTreatment limited to three to five days 2x daily and only to treat severely inflamed irritant diaper dermatitis due to increased absorbtionOnly 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 dailyAvoid:Neosporin/Bacitracin due to increased allergic likelihood to neomycin