Diaper dermatitis (DD) is an acute, occasional inflammatory condition which is characterized by erythema, pustules and papules, in the diapered area. Diaper dermatitis has various causessuch as skin overhydration, friction, frequent or prolonged exposure to urine or feces and related raised skin pH and variations in the skin microbiome.

The objective of this study is to compare incidence and severity of diaper dermatitis in infants and toddlers across three countries namely China, Germany and USA with diapered skin measures and caregiver practices.

A cross‐sectional study of 1791 babies were enlisted at each clinical site. Based on their regional toilet‐training habits, exclusively diaper‐wearing babies were enlisted between ages 2‐8 months in China and 2‐18 months toddlers in the USA and Germany. DD was evaluated along with skin pH, relative humidity (RH) and trans-epidermal water loss (TEWL) in the diapered region. Caregiver practices were also collected through a question naire and comprised information on hygienic practices.

Diaper dermatitis was seen highest in the perianal area and was followed by the genital, intertriginous and buttock regions. Overall, DD was significantly lesser in babies in China. DD was highest in babies from Germany and intermediate in the USA babies. The rank order of DD by geography was observed in baby of age 2‐8 months. The lower DD was detected in China and was also related with lower skin pH and TEWL on diapered skin and reduced RH in the diaper. Chinese caregivers had the uppermost rate of prophylactic topical product usage along with the healthiest cleaning of the diapered area and lack of cleansing after urine‐only diaper changes. Chinese infants spend the least time in an overnight diaper.

The study data recommends that the caregiver behaviors including prophylactic use of topical products, systematic cleaning after stooling and reduced time in an overnight diaper are related with less DD, enhanced skin barrier and lower superficial skin pH.

Source: Carr AN, DeWitt T, Cork MJ, et al. Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior. PediatrDermatol. 2020;37(1):130-136. doi:10.1111/pde.14047