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					                                                                             Oklahoma State Department of Health
                                                                                              01-2009 Reviewed


                                PHN GUIDELINE: DERMATITIS/DIAPER

I.     DEFINITION:

       Inflammation of the skin within the area usually covered by the diaper.

II.    ETIOLOGY:

       A.      Contact irritants (urine, stool, chemicals, etc.).

       B.      Infection (bacterial, fungal, viral); primarily, Candida.

       C.      Underlying skin disorder.

III.   CLINICAL FEATURES: (Diagnostic Criteria):

       A.      Signs and Symptoms:

               1.      Pruritus and irritability sometimes present.

               2.      Erythema on perianal area implicates prolonged contact with feces, thighs and
                       waistband lesions implicate prolonged contact with urine.

               3.      Candida characteristically produces diffuse erythema, beefy red, well-demarcated
                       lesions with elevated margins and satellite lesions may also present as erosions,
                       pustules, and erythematous. Check for concomitant oral thrush.

       B.      Differential Diagnosis:

               Allergic contact dermatitis, seborrheic dermatitis, or atopic dermatitis.

       C.      Complications:

               Secondary bacterial infection.


IV.    MANAGEMENT PLAN:

       A.      Treatment:

               1.      General

                       a.        Keep diaper area dry and clean. Wash skin with plain water at each
                                 diaper change.
                       b.        May use plain water or non-perfumed, mild soap. Avoid the use of
                                 commercial diaper wipes, which are often perfumed and irritating.
                       c.        Allow air to circulate under diaper. Do not use plastic pants.
                       d.        Expose affected area to air at least 15 minutes, 4 times/day and PRN
                       e.        Sit child in vinegar solution for one minute. One tablespoon of white
                                 vinegar per one gallon of water for appropriate vinegar solution.
                       f.        Discontinue all powder and creams. Once the infection is resolved, you
                                 may judiciously use zinc oxide as a barrier cream.
                       g.        Rinse diapers well to remove soap and do not use fabric softeners.




                                                                                           Dermatitis/Diaper - 1
                                                                             Oklahoma State Department of Health
                                                                                              01-2009 Reviewed


                       See PHN ORDER: DERMATITIS/DIAPER

               2.      Non-Candidal

                       See PHN ORDER: DERMATITIS/DIAPER

               3.      Candidiasis

                       See PHN ORDER: DERMATITIS/DIAPER

               4.      Bacterial infections

                       See PHN GUIDELINE AND ORDER: IMPETIGO

       B.      Prevention:

               1.      Instruct parent/caregiver in causes of diaper rash.

               2.      Discuss the need to check the child frequently for wet or soiled diapers.
                       Especially important when using disposable diapers or plastic pants.

               3.      Encourage good hand washing practices in the home.

               4.      Instruct parent/caregiver in proper skin care and care of diapers, as indicated.

       C.      Referral:

               1.      Moderate to severe inflammation with weeping.

               2.      Refer to ARNP or physician if fails to respond to treatment within one week.

               3.      Severe candidal diaper rash should be referred to nurse practitioner or physician
                       for treatment.

       D.      Follow-up:

               1.      Return visit PRN.

               2.      Determine tracking priority utilizing professional judgment.


REFERENCES:
                                              th
Wong’s Nursing Care of Infants and Children, 7 Ed. 2003. Wong, D.L. & Hockenberry, M.J. p. 578-579.
                                   th
Nelson’s Textbook of Pediatrics,.17 ed. 2004 pp 1013, 2188-2189, 2234-2235.
Kazaks, EL & Lane, AT, Pediatric dermatology: Diaper dermatitis. Pediatric Clinics of North America,
   47:4, August, 2000.
Habif, TP Skin Disease Diagnosis and Treatment 2001 Mosby p. 178-179.




                                                                                          Dermatitis/Diaper - 2
                                                                      Oklahoma State Department of Health
                                                                                       01-2009 Reviewed


                              PHN ORDER: DERMATITIS/DIAPER


1.   Non-Candidal

     Mild - moderate inflammation. Apply petrolatum, A & D Ointment, zinc oxide, Desitin, Daily Care
     or other OTC preparation after each diaper change. Diaper area should be gently cleansed of
     ointment and ointment re-applied at each diaper change.

2.   Candidiasis

     In mild to moderate cases, apply Nystatin ointment or cream liberally to affected area with each
     diaper change, or apply 3 - 4 times a day until healing is complete.




                                                                                   Dermatitis/Diaper - 3
Oklahoma State Department of Health
                 01-2009 Reviewed




             Dermatitis/Diaper - 4

				
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