What are fissures in the groin area caused by diapers?

Diaper-Related Groin Fissures: Intertrigo

Fissures seen in the groin area due to diapers are called intertrigo, a form of irritant contact dermatitis that occurs in skin folds and intertriginous areas. 1

Pathophysiology of Diaper-Related Intertrigo

• Diaper dermatitis with intertrigo develops due to prolonged skin exposure to moisture, friction, and irritants in the diaper environment 2
• The moist, occlusive environment created by diapers increases skin hydration and raises skin pH, which impairs normal barrier function 2
• Skin folds in the groin area are particularly susceptible to maceration and fissuring due to:
  • Increased moisture retention between skin surfaces 1
  • Friction between opposing skin surfaces during movement 1
  • Chemical irritation from urine and feces 2

Clinical Presentation

• Early stages present with skin dryness in the affected groin folds 1
• As the condition progresses, erythematous maceration and edema develop 1
• Fissures typically form in the skin folds of the groin where opposing skin surfaces rub together 3
• The condition may involve the lower abdomen, thighs, and entire diaper area 1
• Pain or discomfort may occur, particularly with movement or during diaper changes 1

Complications

• Secondary infections can complicate diaper dermatitis with intertrigo:
  • Candidal infection (most common) presents with sharply marginated erythema and satellite lesions 3
  • Bacterial infections, particularly with Staphylococcus aureus, may develop 3
• Chronic cases may progress to noduloulcerative diaper dermatitis with raised erosions and rolled margins 3

Differential Diagnosis

• Atypical fissures or those not responding to treatment should prompt investigation for underlying conditions such as:
  • Inflammatory bowel disease (Crohn's disease) 4
  • Lichen sclerosus, especially if fissures are midline 4
  • Anal fissures (typically posterior midline) 4, 5
  • Seborrheic dermatitis 1, 3
  • Psoriasis 1

Management

• The cornerstone of treatment is keeping the area clean and dry:

  • Frequent diaper changes to minimize skin exposure to moisture and irritants 1
  • Gentle cleansing with water; avoid soap and alcohol-containing products 1
  • Thoroughly dry the area after cleaning 1
  • Use of superabsorbent disposable diapers to decrease moisture contact 1

• Topical barrier products:

  • Zinc oxide-based barrier creams create a protective layer between skin and irritants 6
  • Products containing panthenol and glycerin help restore skin barrier function 6
  • Apply barrier cream at each diaper change 6

• For inflamed areas with fissures:

  • Mild topical corticosteroids may be used for short periods to reduce inflammation 1
  • Antifungal agents should be added if candidal infection is suspected 1
  • Calcineurin inhibitors may be beneficial in some cases 1

Prevention

• Preventive measures include:
  • Allowing diaper-free time to expose skin to air 2
  • Using diapers that maintain an environment closer to normal acidic pH of skin 2
  • Avoiding tight-fitting diapers that increase friction 1
  • Addressing nutritional deficiencies that may contribute to skin fragility 1

Special Considerations

• The condition affects both infants and adults who use diapers 6
• Treatment approaches are similar regardless of age, with barrier creams showing efficacy in both populations 6
• Persistent or worsening fissures despite appropriate treatment warrant further investigation for underlying conditions 4, 5