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.

• 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]

• Weakness

  This is not a good option for adults since our stomach acid will kill the bacteria in capsulized probiotics that are designed to release the bacteria in the intestines, but babies have weak stomach acid that bacteria easily passes through. [naturalnews.com]

  Make a very weak vinegar solution by adding one teaspoon of white vinegar to one cup of water. Use this solution to wipe your baby’s bottom when changing the diaper. This simple step will help to make your baby’s bottom resistant to yeast. 2. [top10homeremedies.com]

  The most severe form is caused by P. falciparum; variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, diarrhoea and abdominal pain. [who.int]

• Fatigue

  More: Ask the Pharmacist: Hormone strategies for fatigue and menopause Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com. [eu.marconews.com]

  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]

• Vomiting

  He had vomited a few times before his parents brought in him. By the time the nurse called, the child was feeling better. Poison Control told the nurse that vomiting is expected from swallowing a large amount of diaper cream. [poison.org]

  Possible Symptoms of Overdose/Poisoning : Loose stools You should be concerned if your child experiences these symptoms: vomiting (more than once), persistent/continued diarrhea, choking. Call your local Poison Center right away at 1-800-222-1222. [illinoispoisoncenter.org]

  […] child by demonstrating to a dumbstruck judge what she could manage: she changed the baby's diaper with her teeth.(2) Symptoms include fever lasting two to three days, sore throat, runny nose, mouth ulcers, rashes on the hands, feet and diaper areas, and vomiting [urdu.english-dictionary.help]

  The most severe form is caused by P. falciparum; variable clinical features include fever, chills, headache, muscular aching and weakness, vomiting, cough, diarrhoea and abdominal pain. [who.int]

  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]

• 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]

• 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]

• 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 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]

  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]

• 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]

• Skin Disease

  Matthias Fischer, Thomas William and Johannes Wohlrab, Skin diseases in intensive care medicine, JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 7, 2, (108-115), (2008). [doi.org]

  Photo Credit Gracia Lam Personal Health A Little-Known Skin Disease That Can Disrupt People’s Sex Lives Patients deal with pain and itching and often encounter medical ignorance and mistreatment until affected tissues become irreparably scarred. [nytimes.com]

  But in pemphigus, the body produces antibodies that damage cells of your skin and mucous membranes. Pemphigus isn't contagious. In most cases, it's unknown what triggers the disease. [mayoclinic.org]

  Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 58. Ericson J, Smith PB, Benjamin DK. Candida. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. [nlm.nih.gov]

  Candida is a yeast (fungus) that causes mild disease, but in immunocompromised individuals it may cause life-threatening illness. (Image courtesy of the Centers for Disease Control and Prevention.) [mountsinai.org]

• Skin Rash

  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]

  Diaper rash Frequent skin problems The diaper area’s very delicate skin can easily become irritated, especially during the baby’s first year of life. Up to 60% of infants are affected during the first 12 months. [mustela.ph]

  When you check his diaper, you see blotchy red skin that looks like it's been burned. This is a classic sign of diaper rash. Diaper rash is a form of dermatitis, a skin rash that happens when the area of skin covered by the diaper becomes inflamed. [health.howstuffworks.com]

  Most diaper rashes are a result of skin irritants (urine and/or stool) inflaming immature, vulnerable skin. Such a rash is termed a contact skin irritant rash. [medicinenet.com]

• Stupor

  Acute encephalopathy associated with convulsions, drowsiness, stupor and coma. Patients may manifest signs consistent with an upper motor neuron lesion, extensor posturing, and disconjugate gaze. [infectiousdiseaseadvisor.com]

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.

• Candida

  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. [symptoma.com]

  Causes of Diaper Rash Diaper rash is caused by an overgrowth of Candida. Candida is a yeast or fungus that is found in nearly every environment. Candida thrives in warm moist places, such as under a diaper. [medicalbug.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]

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.