Diaper dermatitis (DD) is the most common skin disorder among the infant population and occurs mostly in 50% of children mostly in the age group of around 9 to 12 months. It is defined as an inflammatory reaction of the skin of the perineal and perianal areas (diaper area). It was first identified in the 1940s and is still very common.^1,2 

It is most commonly caused by irritation of the skin; atopic dermatitis and seborrheic dermatitis which can present as a diaper rash. Fungi such as Candida albicans is another common cause of Diaper dermatitis (DD) which can be primary or secondary. Also, Bacterial infections caused by Staphylococcus aureus and Streptococcus pyogenes cause Diaper dermatitis (DD). DD may be caused due to several combined factors including irritants like detergents, excess moisture, prolonged contact with urine or faeces, etc. Continuous wearing of Diapers results in prolonged time the skin is in contact with excess moisture, which causes friction and maceration making the skin more prone to damage and increases the chances of infection. Irritant dd is characterised by dryness/scaling, aberrant desquamation, erythema. It also includes generalized contact irritant dermatitis, miliaria, intertrigo and candidiasis.^3,4

The infant skin is very mild and tender, so it is more susceptible to infections. As the child grows, changes occur in the microbiota of the intestine due to the diet, which also changes in the pH of the stool, which may lead to the formation of rashes, the best way to protect this is breastfeeding. Also, if more number of times the diaper is changed the lesser is the infection chances.

The clinical characteristics of infants related to Diaper dermatitis (DD) are very important to decide the exact treatment and need to be taken care of. The clinical characteristics include keen observations on a) Gestational period, b) Types of feed; c) Stool frequency ; d) History of DD; e) Use of antibiotics and f) delivery mode (vaginal or cesarean section) and phototherapy. In some cases, it becomes important to understand the type of diapers being used, type of skincare products being used.^4,1

Studies have shown that premature infants are at a higher risk of developing DD because of poorly developed cornified layers. In premature babies, the natural moisturizing factor (NMF) is very low. Also, the skin pH decreases for 4 weeks after birth in underweight babies. Thus the overall barrier development is slow which makes them vulnerable to various skin infections including Candida albicans, Staphylococcus aureus and Streptococcus pyogenes. In another  study it was observed  that perineal eruption was most common (73%), rashes in the perineal area or whole area was 17%, rash with perianal nodule was 4.5%, the psoriasis-like rash was 1.7% and partial eruption of infantile dermatitis was 1.5%. Further, it was observed that 54.3% of rashes were due to Candidiasis and related to cotton diapers with plastic covers.⁴

A study reported by Carmen Alonso, et al conclude that The use of antibiotics and oral 50% glucose, as well as an increased number of stools, are associated with a higher incidence of diaper rash.⁴

Diaper dermatitis (DD) may be prevented by the use of a Diaper dermatitis-specific skin assessment tool which can work by correlating the clinical characteristics with DD development. A safety  model  (SSM)  was identified to guide the identification and interpretation of clinical characteristics with reference to skin vulnerability factors such as friction, shear, and irritants, other patient factors, situational stressors, and system factors.¹

Carmen Alonso, et al conclude that breastfeeding and phototherapy were effective protective factors for babies against Diaper dermatitis (DD) and other treatments may include topical treatments including the provision of the semi-permeable layer to enhance the skin repair, a physical barrier to decrease the contact with skin irritants, including ingredients which help to deactivate some specific facial components which are not removed during defecation. Various tropical oils such as sunflower seed and safflower, potato tuber protein, vernix caseosa films, some stratum corneum ceramides and skin surface pH for balancing and restoring the epidermal barrier is suggested.^4,1

Thus, the  a continuous monitoring of clinical characteristics  along with  adequate research are very essential and critical for assessing an infant’s risk of developing Diaper dermatitis (DD) and thus may help to understand the treatment strategies better.

Reference:

1. Mendez., A. B. B. O. M. D. Diaper Dermatitis. StatPearls Publishing: Treasure Island (FL):, 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559067/
2. Carrie C Coughlin 1, L. F. E., Ilona J Frieden. Diaper dermatitis: clinical characteristics and differential diagnosis. Pediatr Dermatol,2014, Volume31, Issues1, Suppl 1:19-24. , 19-24.
3. Carmen Alonso, I. L., Esther Bon, Mari Mar González, María Teresa Iglesias, Iratxe Urreta,; Emparanza, a. J. I. Efficacy of petrolatum jelly for the prevention of diaper rash:A randomized clinical trial. Journal for Specialists in Pediatric Nursing, 2013, 18(2),, 123–132. .
4. Visscher, M. O. Recent advances in diaper dermatitis: etiology and treatment. . Pediatric Health; 2009, 3(1), , 81–98.