Although the majority of rashes in the diaper area are due to irritation from urine and feces, irritant diaper dermatitis (IDD), there can also be some infrequent but potentially serious cutaneous eruptions associated with systemic diseases that should not be overlooked.

A study by Lebsing S. et al. explored variations in cutaneous disease in the diaper area by enrolling three hundred consecutive patients with rashes in the diaper area. They observed the most common diagnosis as IDD (41.7%), followed by rashes exacerbated by the diaper (33.67%), including Intertrigo, Candida albicans diaper dermatitis, Seborrheic dermatitis, Psoriasis, Impetigo (Streptococcal/ Staphylococcal infection), and non-diaper-related rashes (24.67%) including Eczema, Hemangioma, Hand foot mouth disease, Acrodermatitis enteropathica, Staphylococcal scalded skin syndrome (SSSS), Langerhans cell histiocytosis (LCH), Scabies, Henoch Sherleiin Purpura (HSP), Steven Johnson syndrome, Lichen Sclerosus et Atrophicus (LS&A), Wart, Kawasaki disease, Bullous pemphigoid, and Epidermolysis bullosa.

Their finding is essential to understand that when diagnosing rashes of the diaper area, general pediatricians should consider, in addition to IDD, the possibility of less-common conditions. The concurrent presence of cutaneous lesions at other sites correlates with the diagnoses of systemic diseases other than IDD.

Lebsing S, Chaiyarit J, Techasatian L. Diaper rashes can indicate systemic conditions other than diaper dermatitis. BMC Dermatol. 2020 Sep 21;20(1):7. doi: 10.1186/s12895-020-00104-z. PMID: 32957981; PMCID: PMC7507743.