Diaper rash and dermatitis

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					Diaper rash and dermatitis
Cutaneous inflammation at the area of
skin covered by infant's diaper
             Prevalence: 
Common in infancy 25% of infants
had diaper rash.
Factors that increase the risk of
diaper rash:
1. Age:
High risk at age of 3 – 6 months
After 15 months the risk decrease because
of more muscular control  does not
urinate and defecate as often.
2. Atopic dermatitis:
*It is an inflammatory, chronically
replacing ,
Non-contagious , and pruritic skin disorder.
*30% of infant with atopic dermatitis had
diaper rash.
The effect was noted only in infant age 3-6
months rather than older children
3. Diarrhea:
In this case the feces is more liquid 
spread more readily across the skin
skin damage
4. Type of diaper :
*reusable diaper more risk to
develop diaper rash.
*disposable diaper contain of cellulose or
fiber core absorb moisture from urine or
feces .
5. Nutritional factors:
*Kwashiorkor: malnutrition usually caused
by protein deficiency.
*acrodermatitis enteropathica: defective zinc
metabolismcausing dermatologic
*zinc deficiency, bottle fed babies  suffer
From diaper dermatitis more commonly
than other
etiology of diaper rash:
Occlusion , humidity and friction:
When the skin is wetted  the fraction
coefficient of the skin increase  more
damage from minor abrasion.
Contact irritation:
Wet skin decrease the normal barrier
and increase the permeability 
Allow urine and stool to accelerate skin
-laundry soap, fabric softener , or bleach
used to wash reusable diaper  irritant
contact dermatitis.
 Skin PH and fecal enzymes:
*normal skin ph is 4 – 5.5 .
*Skin occlusion  elevate skin ph
*Bacteria on the skin metabolize
urine to form ammonia  elevate skin ph
*at elevated ph the lipase and protease
enzyme found in feces activated 
  skin breakdown due to proteolytic
action, increase permeability of the skin
to bile salts which cause skin irritation
Candidal growth :
 Candida albicans has extended from infant
GIT reservoir to affect the diaper area by
feces contact with skin, the recurrence is
likely to occur
Medical condition:
Such as psoriasis , atopic dermatitis,
seborrheic dermatitis diaper dermatitis
Manifestation of diaper dermatitis.

most cases are mild & cause no symptom.    
Visible symptom of diaper rash is mild 
erythema, seen as shiny patches on the
buttock, upper thighs, abdomen, & pubic
There is no lesion or ulceration. 
Candidal rash: satellite lesion with ◦
intensive red beefy erythma, and the
child shows violent crying when
urinate or defecate.
If diaper dermatitis is not treated this
may lead to bacterial ,viral, or fungal

Miliaria occur because eccrine sweat duct
outflow is disrupted or when sweat is
1- role of the diaper
Diaper must changed frequently
Diaper rash is less in high
absorbance diaper
2- cleanliness
Washing the diaper area with warm water
and mild soap or gentle cleanser and then
drying the skin
*Chemicals found in diaper wipes can cause
 skin irritation and this wipes contain
alcohol cause pain to irritant skin
3- skin hydration
The skin must not be over hydrated 
hasten breakdown of skin
But kept moist by using emollient
Diaper rash that is self-treatable is 
limited to mild skin redness (no lesion
or skin damage).
Sign of bacterial or fungal infection (ulceration
,erosion ,lesion) require referral.

If more than 7 days secondary infection with
Candida, especially if the skin is broken 
require referral.
Factors considered
Nature of diaper (the occlusive nature of
diapers helps to facilitate transcutaneous
absorption of medication).

-Infant don’t metabolize or detoxify
medications as well as adult.

Many enzyme systems are absent or deficient
in neonatal
-The diaper area is relatively large
percentage of the infant’s body
surface area.

Conclusion: Because of all these
factors , pharmacists must take
great care to use only safe &
effective medication
Safe & effective medication.
1.   Skin protectants considered the only
     ingredients safe &effective for diaper rash:

1.    Talc( 45-100%)emollient effect on skin,
     also absorbs sweat.
2.    Corn starch (10-98%)protect skin
     through absorbent action.
3.    Zinc oxide (1-25%)/ Zinc oxide
Cautions :

1. talc  & corn starch must be used with caution
     since it is powder and could cause breathing
     problems (keep away from child’s face).

2.   Don’t use powder on broken skin.

3.    avoid Mercury preparation because it is
     hazardous over a large area.

4. The   use of anti fungal, anti bacterial,
     external analgesics, hydrocortisone should be
In persistent or especially bad 
rashes, an antifungal cream often
has to be used. In cases that the
rash is more of an irritation, a
mild topical corticosteroid
preparation, e.g. hydrocortisone
cream, is used
Drug name         Active               company
caladerm          Calamine,dermat      ‫شركة القدس‬
                  ol, zinc oxide
Cool oint.        Zinc oxide           ‫شركة القدس‬

Calamine lotion   Calamine , zinc      floris
Panthe vera       D-panthenol, aloe    pharmix
hydrogel          D-panthenol,aloe     gikopharm
                  vera , pyridoxine,
                  zinc , vit B6
Decomb ,          Neomycin,nystati     BPC ,Taro
dermacombin       n, gramicidin,
Baby cure         Calamine , zinc      GAMA
                  oxide , starch
dermagesic        Calamine ,zinc       BJP
                  oxide ,
desitin   Cod liver oil , vit A,D ,   pfizer
          zinc oxide
Zinc Oxide 10%
Balmex ointment
Zinc oxide with Aloe Vera and vit E 

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