From the Guidelines
Prolonged diaper dermatitis is primarily caused by a combination of factors including irritants, allergens, and infections, which can be exacerbated by poor skin care and hygiene practices. According to the Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis, several risk factors can induce skin flare-ups, including dry skin, excessive sweating, changes in temperature or humidity, irritants, allergens, infections, and stress 1.
Key Factors Contributing to Prolonged Diaper Dermatitis
- Irritants and allergens can cause skin irritation and allergic reactions, leading to prolonged diaper dermatitis
- Infections, such as bacterial or fungal infections, can also contribute to the development of prolonged diaper dermatitis
- Poor skin care and hygiene practices, such as infrequent diaper changes and inadequate cleaning, can exacerbate the condition
Recommendations for Management
- Regular use of emollients, such as moisturizers, can help to improve skin barrier function and reduce the risk of skin flare-ups 1
- Topical corticosteroids (TCSs) can be effective in reducing inflammation and immune response in atopic dermatitis, but should be used with caution and under medical supervision 1
- Proactive therapy with twice-weekly application of TCSs or topical calcineurin inhibitors (TCIs) to previously affected skin areas may help to prevent relapses in children with moderate to very severe atopic dermatitis 1
Importance of Proper Skin Care and Hygiene
- Frequent diaper changes and gentle cleansing can help to prevent skin irritation and infection
- Allowing the skin to dry completely before applying a thick layer of barrier cream, such as zinc oxide or petroleum jelly, can help to protect the skin and prevent further irritation
- Avoiding irritants, such as fragranced products and baby powder, and using gentle, fragrance-free cleansers can also help to reduce the risk of skin flare-ups.
From the Research
Causes of Prolonged Diaper Dermatitis
The causes of prolonged diaper dermatitis can be attributed to several factors, including:
- Friction, excessive hydration, and varying pH in the diaper area 2
- Constant contact with urine and feces, which are highly irritant to the skin 2
- Presence of Candida albicans and Staphylococcus aureus, which are thought to have a predominant role in diaper dermatitis 2
- Inadequate skin care and failure to prevent moisture and irritants from coming into contact with the skin 3, 4
Role of Skin Microbiota
The skin microbiota in the diaper area plays a significant role in the development of diaper dermatitis, with Candida albicans and Staphylococcus aureus being the most frequently isolated microorganisms 2, 5
Prevention and Treatment
Prevention and treatment of diaper dermatitis involve:
- Appropriate skin care, including gentle cleansing and the use of barrier emollients 2, 3
- Frequent diaper changes to keep the skin dry and reduce exposure to irritants 4
- Use of antifungal pastes, such as clotrimazole or nystatin, in cases of Candida superinfection 5
- Consideration of differential diagnoses in cases of atypical presentation or unresponsiveness to treatment 6