On history

• The babies have itching and rash in the region of the diapers. The rash usually resolves in 3 days.
• In Candida dermatitis, the rash is very painful and takes a much longer time to resolve.
• In Staphylococcal diaper dermatitis, there is history of fever, pus drainage and lymph node infections.

On examination

• In irritant dermatitis, the skin is erythematous and scaly, often with papulovesicular and bulbous fissures and erosions. There eruptions can be patchy and confluent. The inguinal folds are often spared.
• Candida dermatitis appears as bright red eruptions with sharp borders and pinpoint satellites papules and pustules. There is oral thrush present. This is usually secondary to parenteral antibiotic therapy.
• In staphylococcus diaper dermatitis, there are thin walled pustules on an erythematous base (larger than those seen with Candida dermatitis). These pustules rupture rapidly producing scaling around the red base.

• Pain

  Pink rashes are not painful, but raw ones can be very painful. This can lead crying and poor sleep. Prevention of Recurrent Diaper Rash Change diapers more often. Focus on preventing skin contact with stool. [seattlechildrens.org]

  Draw an oatmeal bath iStock/Anna Pustynnikova Oatmeal is one of the most effective ways to reduce the pain from a diaper rash. Colloidal oatmeal works in two ways. It sooths the pain and dries the skin. [rd.com]

  But again, it really hurts and is not something I recommend for babies unless the rash is beginning to do damage or is so painful that the pain factor becomes irrelevant. [naturalnews.com]

  Once the skin’s protective barrier is broken, the area is even more sensitive to irritation, causing redness and pain and opening the door for bacteria or yeast to cause infection in the area. [winniepalmerhospital.com]

• Fever

  In case of secondary bacterial infection, the rash is often accompanied by fever; whereas in case of Candida infection, oral thrush is also often present. Diaper rash usually resolves within 3 days. [symptoma.com]

  Signs of a skin infection may include a fever, blisters, pus that drains from the rash, and a rash that does not go away after treatment or worsens. Another sign of a skin infection is if the baby is in pain or is hard to console. [aad.org]

  If the infant develops a fever If the baby is taking or exposed to antibiotics through breast milk and develops a rash that is red and has spots around the edges. This could be a yeast infection. [medicalbug.com]

  The baby has a fever along with a rash. Diaper Rash (PDF) HH-I-28 10/75, Revised 5/17 Copyright 1975, Nationwide Children’s Hospital [nationwidechildrens.org]

  Another sign of a skin infection is if the baby has fever, is in pain or is hard to console. Treatment for Diaper Rash Try different types of creams and ointments to see which one works out best for the child. [firstderm.com]

• Inflammation

  Benefits: Effective for the treatment and management of diaper rashes Treats rashes and relieves redness and irritation naturally Keeps baby's skin soft and comfortable Key ingredients: Yashad Bhasma Protects skin from infections Reduces skin inflammation [indoshop.co.kr]

  Diaper dermatitis (diaper rash) is inflammation of the skin in the diaper area. It is a very common condition in babies and toddlers. In most cases, diaper dermatitis is a type of contact dermatitis. [childrensnational.org]

  Such eruptions can be subdivided into primary diaper dermatitis, an acute inflammation of the skin in the diaper area with an ill-defined and multifactorial etiology, and secondary diaper dermatitis, a term which encompasses eruptions in the diaper area [ncbi.nlm.nih.gov]

  The oil has anti-allergic properties that can help soothe and relieve inflammation associated with diaper rash. For treating diaper rash, you can use plantain oil or the herb. [top10homeremedies.com]

  Calendula reduces inflammation, tightens tissues, and disinfects. It is recommended for seborrheic dermatitis as well as for general inflammation of the skin. The ointment should be applied at each diaper change. [healthofchildren.com]

• Swelling

  About Ingredients: Suggested Products: Description Topical Spray Skin Rashes - Itching - Sores - Swelling Indications: For the temporary relief of skin rashes, itching skin, sores, swelling, inflammation, red and swollen skin, scaling and painful burning [seagateproducts.com]

  Excessive moisture in the skin makes it more easily penetrated by irritants and more vulnerable to swelling. Chafing from friction or rubbing. Friction can weaken the protective barrier of the skin. [desitin.com]

  Symptoms of an infected diaper rash include: blisters on the diaper area fever redness swelling of the area pus or discharge that drains from the diaper area rash will not go away after treatment or starts to worsen Your baby’s rash can also develop into [healthline.com]

• Candidiasis

  Candidiasis is suspected when intertiginous areas are involved or when the rash fails to respond to symptomatic treatment. Potassium hydroxide (KOH) scrapings can show pseudohyphae in suspected cases of candidiasis. [symptoma.com]

  The results of these studies show that tioconazole cream 1% is safe and effective for the treatment of neonates and infants with dermal candidiasis, diaper rash and impetigo. [ncbi.nlm.nih.gov]

  Convert to ICD-10-CM : 691.0 converts directly to: 2015/16 ICD-10-CM L22 Diaper dermatitis Approximate Synonyms Candida diaper rash Candida, diaper rash Diaper candidiasis Diaper dermatitis Diaper rash Applies To Ammonia dermatitis Diaper or napkin: dermatitis [icd9data.com]

  Diaper candidiasis: infants can also be predisposed to secondary infection by C albicans. [dermatologyadvisor.com]

  If oral thrush or perianal candidiasis is present or if repeated bouts of candidal dermatitis have occurred, oral nystatin should also be prescribed. [emedicine.medscape.com]

• Dyspnea

  The patient showed a good clinical response under nivolumab therapy with reduced thoracic pain and less dyspnea. Carcinoembryonic antigen (CEA)-values decreased accordingly. [frontiersin.org]

• Diarrhea

  A lick or swallow of a zinc oxide or lanolin cream is not dangerous to a child; larger amounts can cause nausea, vomiting, and diarrhea, though this is unusual. Petroleum jelly is used as a moisture barrier by some parents. [poison.org]

  The best way to prevent diaper rash is to change your baby’s diaper often, especially if your baby has diarrhea. [caringforkids.cps.ca]

  Diarrhea Diaper Rash. Rashes just found around the anus are common during bouts of diarrhea. Diarrhea stools also contain enzymes that digest food and irritate the skin. Yeast Diaper Rash. [seattlechildrens.org]

  Friction from diapers, contact with feces and urine, teething, the introduction of solid foods, an episode of diarrhea, an infection and certain medications can all cause diaper rash. While generally harmless, diaper rash must not be neglected. [mustela.ph]

  When the baby has diarrhea, excessive amounts of enzymes such as proteases and lipases are excreted in the stool. These fecal enzymes also increase the hydration of the skin and its permeability to bile salts, which also act as skin irritants. [symptoma.com]

• Nausea

  A lick or swallow of a zinc oxide or lanolin cream is not dangerous to a child; larger amounts can cause nausea, vomiting, and diarrhea, though this is unusual. Petroleum jelly is used as a moisture barrier by some parents. [poison.org]

  Last Update: 2017-04-26 Usage Frequency: 5 Quality: English The most common side effects with Invanz (seen between 1 and 10 patients in 100) are headache, diarrhoea, nausea (feeling sick), vomiting, rash (including nappy rash in children), itching, problems [mymemory.translated.net]

  The most common possible adverse events associated with nivolumab include fatigue, skin rash, pruritus, immune-mediated pneumonitis, colitis/diarrhea, nausea, pyrexia and thyroid dysfunction (5–7). [frontiersin.org]

• Failure to Thrive

  Dermatitis with –Painful or difficult urination (could indicate a Jacquet’s dermatitis) –Perianal pseudoverrucous papules and nodules (can correlate with a history of Hirschsprung disease, encopresis, or urinary incontinence) –Diarrhea, failure to thrive [dermatologyadvisor.com]

• Dermatitis

  In Candida dermatitis, the rash is very painful and takes a much longer time to resolve. In Staphylococcal diaper dermatitis, there is history of fever, pus drainage and lymph node infections. [symptoma.com]

  Contact dermatitis Irritant contact dermatitis is most likely made up of some combination of intertrigo and miliaria. In addition, it has been shown to result from the irritating effects of mixing urine with feces. [emedicine.medscape.com]

  Convert to ICD-10-CM : 691.0 converts directly to: 2015/16 ICD-10-CM L22 Diaper dermatitis Approximate Synonyms Candida diaper rash Candida, diaper rash Diaper candidiasis Diaper dermatitis Diaper rash Applies To Ammonia dermatitis Diaper or napkin: dermatitis [icd9data.com]

  […] include seborrhoeic dermatitis and atopic dermatitis. [en.wikipedia.org]

• Blister

  The skin does not need to be broken down with blisters or rash to be called diaper rash. Diaper rash is usually caused by skin being exposed to moisture (urine and bowel movements) for too long. [nationwidechildrens.org]

  This means seeing pimples, blisters, ulcers, large bumps, or sores filled with pus. Another sign of a skin infection is if the baby has fever, is in pain or is hard to console. [firstderm.com]

  If pimples, blisters, large bumps, or pus-filled sores begin to appear. If the infant develops a fever If the baby is taking or exposed to antibiotics through breast milk and develops a rash that is red and has spots around the edges. [medicalbug.com]

  The blisters don’t itch. They can be painful. Blisters may then appear on the skin and sometimes on the genitals. Pemphigus foliaceus Pemphigus foliaceus doesn’t cause blisters in the mouth. The blisters first appear on the face and scalp. [healthline.com]

  Mouth blisters are common. The blisters burst soon after forming, to leave raw painful areas like severe mouth ulcers (mouth erosions). Some people with pemphigus vulgaris only get mouth blisters, without any skin blisters. [patient.info]

• Eczema

  Eczema Some infants have dry, sensitive skin, which can lead to eczema on your baby’s bottom. Your pediatrician can prescribe a special moisturizer or, in some cases, a hydrocortisone ointment, says Dr. Blau. 5. [momtastic.com]

  Eczema and diaper rash Eczema is a skin condition that makes the baby’s skin dry and sore. This may be more widespread around the body. A family history of eczema and nappy rash despite skin care should alert for eczema as a cause for diaper rash. [news-medical.net]

  Eczema - Also known as atopic dermatitis, eczema is characterized by red scaly patches that show up on the legs and in the groin area. Bacterial infections - Bacterial infections such as impetigo are rare. [bluecrossnc.com]

  ECZEMA Appearance: red, itchy, scaly and cracked Location: folds of the skin, elbows, cheeks, back of the knee and bum Cause: unknown but often triggered by heat, dairy, soy and gluten Solutions: Bathe using a gentle castile soap like Dr. [pootersdiapers.com]

• Dry Skin

  If you’re wondering what to do for diaper rash, and newborn skin issues, like dry skin and dry lips here are some tips that may be useful. [vaseline.us]

  Moist skin is more vulnerable to friction than dry skin, so the diaper area is particularly prone to this problem. [desitin.com]

  “Hard Lotion” is the answer to your dry skin issues. It is a lotion “bar” that is solid at room temperature and made with just three ingredients (shea butter, coconut oil and beeswax). [hardlotion.com]

  […] agent so this would not be the choice for dealing with dry skin. [pinstripesandpolkadots.com]

• Eruptions

  Eruptions in the diaper area are the most common dermatologic problem in infancy. [ncbi.nlm.nih.gov]

  There eruptions can be patchy and confluent. The inguinal folds are often spared. Candida dermatitis appears as bright red eruptions with sharp borders and pinpoint satellites papules and pustules. There is oral thrush present. [symptoma.com]

  […] directly to: 2015/16 ICD-10-CM L22 Diaper dermatitis Approximate Synonyms Candida diaper rash Candida, diaper rash Diaper candidiasis Diaper dermatitis Diaper rash Applies To Ammonia dermatitis Diaper or napkin: dermatitis erythema rash Psoriasiform napkin eruption [icd9data.com]

  Background: Napkin dermatitis (nappy or diaper rash) is a non-specific term used to describe inflammatory eruptions (rashes) in the napkin area. Most infants develop napkin dermatitis at least once during their infancy. [cochrane.org]

  Key terms rash [ rash ] a temporary eruption on the skin. butterfly rash a skin eruption across the nose and adjacent areas of the cheeks in the pattern of a butterfly, as in lupus erythematosus and seborrheic dermatitis. [medical-dictionary.thefreedictionary.com]

• Hunger

  By JEN GUNTER Well Photo Credit Illustration by Celia Jacobs Outrunning Hunger Intense exercise may change the way certain neurons influence our appetite and metabolism. [nytimes.com]

• Urinary Incontinence

  and other lower urinary tract symptoms in five countries: results of the EPIC study. [doi.org]

  Agency for Healthcare Policy and Research, Urinary Incontinence in Adults: Clinical Practice Guidelines. Washington, DC Dept of Health and Human Services1996; 7. Berg RW Etiology and pathophysiology of diaper dermatitis. [archpedi.ama-assn.org]

  Incontinence-associated dermatitis from a urinary incontinence perspective. Wilson M. Br J Nurs. 2018 May 10;27(9):S4-S17. doi: 10.12968/bjon.2018.27.9.S4. PMID: 29749768 Similar articles [ncbi.nlm.nih.gov]

  Dermatitis with –Painful or difficult urination (could indicate a Jacquet’s dermatitis) –Perianal pseudoverrucous papules and nodules (can correlate with a history of Hirschsprung disease, encopresis, or urinary incontinence) –Diarrhea, failure to thrive [dermatologyadvisor.com]

• Burning Sensation

  This will help rashes to heal faster and can also reduce the burning sensation. References: American Academy of Dermatology American Academy of Family Physicians [organicfacts.net]

The diagnosis of diaper rash is made clinically. Laboratory testing can help us in excluding other diseases of the skin.

Blood tests may reveal an increased number of white cells in case of Staphylococcal and other infections. Gram staining of pustules can also reveal neutrophils and clusters of gram-positive bacteria.

Candidiasis is suspected when intertiginous areas are involved or when the rash fails to respond to symptomatic treatment. Potassium hydroxide (KOH) scrapings can show pseudohyphae in suspected cases of candidiasis.

• Staphylococcus Aureus

  To investigate the relevance of candida sp. and Staphylococcus aureus colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease. [ncbi.nlm.nih.gov]

  Bacteria like Staphylococcus aureus or group A streptococci can also lead to eruptions in the diaper area. Staph infection is more common in children who have a tendency to develop skin allergies (atopic dermatitis). [news-medical.net]

  This is particularly evident with bullous impetigo in the diaper area, which causes bullae that are flaccid but sometimes tense due to Staphylococcus aureus infection, or a cellulitis due to cutaneous streptococci, or even a folliculitis due to S aureus [emedicine.medscape.com]

The treatment of diaper rash consists of the following [7] [8].

• Water breathable diapers should be used. Furthermore, frequent changing of diapers promotes healing of the dermatitis.
• Gentle, thorough cleansing of the area with warm water and mild non-perfumed soap should be done.
• Application of lubricants and barrier pastes is helpful [9].
• Topical antifungal therapy and oral nystatin are used in case of Candida infection.
• Topical antibiotics are applied in case of staphylococcal diaper dermatitis.
• Avoiding excessive scrubbing and the use of high alkaline soap are necessary.
• Barrier creams (such as zinc oxide paste or petroleum jelly formations) decrease contact of urine and fecal content with the skin.
• Oral zinc can be used [10].
• The use of vitamin A & D ointment and Burrow solution is also helpful in promoting healing.

With the improvement of diaper hygiene, diaper rash usually resolves without any complications. Diaper rash due to Candida albicans may take up to 3 weeks to resolve.

The contributing factors for the development of diaper rash include the following.

• Diarrhea
• Frequent stools
• Allergic reactions
• Infrequent diaper changes
• Bad cleaning of the diaper area
• Failure to apply topical agents
• Air-tight diapers
• Heavy ammonia exposure
• Superabsorbent diapers
• Diapers with dyes

Every child usually has at least one episode of diaper rash in his or her life. The incidence of diaper rash is around 4-35% in the first 2 years of life. The peak incidence occurs at 7-12 months of age.

A decrease in incidence is seen after toilet training of child which occur at 2 years of age. Moreover, the incidence is lower in breast fed babies. The number of incidents are far greater than the cases reported. The cases of atopic dermatitis are more common in African American population.

Oral thrush is also associated with a higher incidence of diaper rash.

Diaper rash occurs due to interaction of a number of factors. These include moisture, friction, urine and feces, lack of air exposure, the presence of microorganisms and the presence of dye and irritant substances. The creases and folds of the skin lead to difficulty in cleaning of the diaper area and are hence more often involved.

Due to excessive hydration, there is softening of the stratum corneum of the skin. This leads to progressive break down of intercellular lipids. Since stratum corneum is a protective layer, this breakdown will lead to the entry of microorganisms in the skin.

Furthermore, when the fecal and urinary ammonia mix in the diaper, it will lead to decreased hydrogen ion concentration causing a further increase in the pH of the skin. This further augments the cycle of breakdown of the skin lipid layer.

Contrary to the popular belief, ammonia itself does not cause dermatitis. When the baby has diarrhea, excessive amounts of enzymes such as proteases and lipases are excreted in the stool. These fecal enzymes also increase the hydration of the skin and its permeability to bile salts, which also act as skin irritants. The alkaline urine causes activation of fecal lipases, ureases, and proteases which further increases the damage to skin [5] [6].

Superabsorbent diapers that contain certain dyes are suspected to cause allergic contact dermatitis. Secondary staphylococcus and streptococcus infections can also further complicate the irritant diaper rash. When the skin is immunocompromised, it will predispose to the development of Candida infections.

• Avoiding the use of air tight diapers.
• Avoiding the use of heavy alkaline soap.
• Education of the parents regarding use of diapers and cleansing of buttocks after diaper use.

Diaper rash or diaper dermatitis is an inflammatory condition of the skin that usually presents with itching and rash in region the diapers are worn [1]. Usually every baby has diaper rash once in his or her life time. Frequent stools and improper use of diapers can lead to repetitive episodes of diaper rash [2].

The high alkaline pH and excessive hydration of the skin lead to breaking of its lipid layer. The mixing of fecal protease and lipase also further increases the pH. In case of secondary bacterial infection, the rash is often accompanied by fever; whereas in case of Candida infection, oral thrush is also often present [3] [4]. Diaper rash usually resolves within 3 days.