DIAPER RASH

Presented by :

Riska
110 203 026
Wa Ode Nur Rahmaniar 110 203 168

Advisor
Supervisor

: dr. Shinta J. B Toban Rambu

: dr. Khaeruddin Djawad, Sp.KK

INTRODUCTION
Diaper Rash is a generalized term
indicating any skin irritation that develops
in the diaper-covered region.
Synonims include diaper dermatitis,
napkin (or nappy) dermatitis and
ammonia dermatitis.

EPIDEMIOLOGY
Diaper rash is the most common
dermatitis found in infancy.
No sexual predilection exists.
Diaper rashes can start in the neonatal
period as soon as the child begins to wear
diaper.
The insidens peaks in those aged 7-12
months, then decreases with age.

ETIOLOGI
Diaper Rash can be traced to a number of
causes, including:
Friction
Irritation from stool and urine
Introduction of new foods
Bacterial or fungi infection
Sensitive skin
Use of antibiotics

PATHOGENESIS
The wearing of diapers causes a significant
increase in skin witness and pH. Prolonged
wetness leads to maceration of the stratum
korneum, the outer, protective layer of the
skin, which is associated with extensive
discruption of intercellular lipid lamellae.

PATHOGENESIS
Weakening of its physical integrity makes
the stratum corneum more susceptible to
damage by:
1.Friction from the surface of the diaper
2.Local irritants

CLINICAL FEATURE
The most common for of primary irritant

napkin dermatitis comprises confluent

erythema of the convex surfaces in closest
contact with the napkin, i.e the buttocks,
the genitalia, the lower abdomen and
pubic area, and the upper thighs.

CLINICAL FEATURE

CLINICAL FEATURE
Occasionally, an erosive form of primary

irritant napkin dermatitis is seen, in which

small vesicles and erosions may develop
into rather characteristic shallow round
ulcers with raised crater-like edges
(Jacquets dermatitis)

ADDITIONAL EXAMINATION
1. Laboratory Studies
The primary form of diaper rash

generally can be diagnosed clinically.

A complete blood count may be helpful,
especially if a fever is present and a
secondary bacterial infection is
suspected.

ADDITIONAL EXAMINATION
2. Histological Picture
Generally that of primary irritant dermatitis
with epidermal spongiosis and mild
inflammatory changes in the dermis

ADDITIONAL EXAMINATION
3. Other Tests
KOH scrapings from a fresh papular or
pustular lesion in suspected cases of
candidiasis.

DIAGNOSIS
The presence of skin lesions in the diaper
area means that the baby has diaper rash.

DIFFERENTIAL DIAGNOSIS
Neonatal Candidiasis

A moist, erosive,
pruritic patch of the
perianal skin and
perineum (with
satellite pustule
formation)

DIFFERENTIAL DIAGNOSIS
Congenital Syphilis

Reddish-brown
macules, sometimes
slightly raised. Bullous
or erosive lesions may
occur in the napkin
area.

DIFFERENTIAL DIAGNOSIS
Zinc Deficiency :

Infant with napkin

eruptions caused by
zinc deficiency usually
have a concurrent
facialis dermatitis.

TREATMENT
Corticostertoid, topical :

Hydrocortisone, apply a thin film topically

to rash qid for 14 days
Antifugal agents :
Nystatin, oral thrush : 4-6mL p.o, swish and
swallow qid. Clotrimazole, miconazole,
ketokonazole, apply topically to rash at
every diaper change until resolved.

TREATMENT
Antibiotics, topical:

Bacitracin, apply topically to rash at every

diaper change until resolved.
Antibiotics, oral
Amoxicillin and clavulanate, <3 months :
125 mg/5mL p.o divided bid for 7-10 days
>3 months :45mg/kg/day p.o divided 12
hours.

COMPLICATION
Skin ulceration and secondary infection

by Candida albicans or bacteria

Jacquet dermatitis
Granuloma gluteale infantum

PROGNOSIS
Most cases completely resolve after a

concerted effort by parents toward diaper

hygiene

THANK YOU