DIAPER RASH by xiuliliaofz


									                                          DIAPER RASH

Contact Dermatitis
        Presentation:
              Convex surfaces sparing the folds
              Erythema has a shiny appearance and tends to wax and wane
              Erythematous papules may be present at the periphery
              Around the belt line is a common place because of the rubbing.
              Happens in many babies: harsh material rubbing on ultrasensitive skin. Can lead to bacterial or
                  fungal growth.
        Cause
              Trapped moisture and friction of diaper
              Following diarrhea
              Allergic contact dermatitis is sometimes seen with disposable diapers and diaper wipes
              Diaper creams such as Neosporin and paraben containing creams may also cause an allergic
                  reaction resulting in a worsening of a treated rash
        Timing:
              Usually not seen until after 3 months of age
              Primary irritant: develops within a few hours of exposure, peaks at 24 hours then
                  spontaneously resolves if no further exposure occurs
        Treatment:
              Assess possible irritant
              Double rinse diapers
              Diaper free time
              Change to cloth diapers from disposables
              Change to wool diaper covers from plastic covers
              Change PH of diaper service diapers
              Ointment to protect from irritant such as diarrhea
              Treat secondary candidal rash
              Diaper cream (check ingredients)
              Lanolin (highly recommended by a mom)
              Apricot kernel oil, olive oil and coat the babies bottom (first poop is meconium: thick and hard
                  to get off, so with a layer of olive oil it is easier to get off)

Atopic Dermatitis
        Presentation:
               Eruptions which ooze and crust
               Lesions can be noted elsewhere on the body, especially the face and extensor surfaces however
                  are usually dry, pruritic patches
               Red ring around the anus
        Causes:
               Hereditary predisposition (Family Hx)
               Food in mom’s diet if baby breastfeeding or in baby’s diet (may see a red ring around mouth)
        Timing:
               Usually not noted before 2 months
        Treatment:
               Eliminate potential food causes
               EFA for breastfeeding mom or food eating baby
               Permeability factors/permeability complex/etc. 1 BID for food eating baby (will go over in
                  further detail later)
               Acidophilus for breastfeeding mom and baby
Bonnie Nedrow N.D., L.M. and Loren Riccio N.D., L.M. 2005
Candidal Infections
       Presentation:
                Perianal erythema with papules and pustules is suggestive of gastrointestinal seeding
                Intensely red beefy rash
                Sharp borders with satellite papules beyond the borders and involves the inguinal folds
                Common to have concomitant thrush
       Causes:
                May occur in infant whose mother had candidal vaginitis at time of delivery or when
                  antibiotics were used in labor
                Secondary to antibiotic use in the baby
                May occur as a secondary infection or be primary
       Treatment:
                Diaper free time
                Change diaper immediately following BM
                Vinegar soak cloth diapers
                Change from disposable to cloth
                Reduce sugar in mom’s diet
                Nystatin diaper cream
                Acidophilus for mom and baby
                Treat associated thrush

Seborrheic Dermatitis
        Presentation:
               Rash starts in the folds and extends to the convex surfaces with poor demarcation from
                 surrounding skin
               Scale is greasy, yellow
               Usually found at other sites, commonly the scalp (cradle cap), face, retroauricular areas,
                 axillae, and neck folds
               Secondary yeast infections common
        Causes:
               Sebum or a breakdown product irritating the skin and causing an inflammatory reaction
               Pityrosporum orbiculare, lipophilic yeast, a normal skin flora
        Timing:
               As early as 3-4 weeks
               Clears spontaneously by 6-18 months
        Treatment:
               Essential Fatty Acids- to mom if breastfeeding, directly to baby if not
               Remove probable food allergens
               Biotin (co-factor for synthesis and oxidation of fatty acids) to mom if breastfeeding: 2-4 mg
               Biotin for babies who are eating food
               Treat secondary candida or bacterial infection
               Allopathic: hydrocortisone 1% cream or ketoconazole cream

Bonnie Nedrow N.D., L.M. and Loren Riccio N.D., L.M. 2005                              page two DIAPER RASH
Staphylococcal Skin Infections
        Presentation:
                Large vesicular (white with a red base) or bullous eruptions
                Tend to rupture easily leaving denuded red base
              Causes:
                    Organism is most often Staph aureus
              Treatment:
                    Diaper free time
                    If in cloth, change to disposable
                    Antibacterial diaper cream: herbal formula, zinc oxide

Staphylococcal Scalded Skin Syndrome (much worse)
        Presentation
                Exfoliation begins around orifices, perineal and perianal areas often affected first
                Rash begins as tender patches of erythema; superficial vesicles appear rapidly then rupture to
                  form yellow crusts overlying the erythema
                Looks like somebody ripped off their skin
        Causes:
                Due to blood borne toxin produced by the organism in a localized infected site
        Treatment:
                Systemic antistaphylococcal drugs

Give babies diaper free time. They love it!
Consider using a different diaper (e.g. Try a cotton diaper because of different material or breathes easier)
Wash cotton diaper in vinegar and DOUBLE rinse them, so no cleaning materials are left on them.
Reducing sugars in the mom's diet (in regards to yeast).
Variety of creams
EFA's for mom

Bonnie Nedrow N.D., L.M. and Loren Riccio N.D., L.M. 2005                                   page three DIAPER RASH

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