Diaper dermatitis refers to various rashes affecting the perineal and perianal areas during diaper use. The most common cause is irritant contact dermatitis, which typically manifests with papules, plaques, and patches, sometimes with maceration or erosion. Other common causes included allergic contact dermatitis and infection. Diagnosis is initially based on clinical evaluation, and treatment of the suspected underlying cause can usually be initiated without further diagnostics. If symptoms worsen despite initial therapy, further diagnostics (e.g., bacterial culture, skin biopsy) guided by history and physical examination findings should be performed.
Overview of diaper dermatitis
|Condition||Etiology||Characteristics of the rash||Treatment|
|Diaper-related||Irritant contact dermatitis (most common cause) || || || |
|Allergic contact dermatitis|| || || |
|Candidiasis|| || || |
|Non-diaper-related||Seborrheic dermatitis|| || || |
|Bacterial infection||Perianal streptococcal dermatitis|| || |
|Impetigo|| || |
|Psoriasis|| || |
The diagnosis of diaper dermatitis is based on clinical evaluation.
- Obtain a comprehensive clinical history.
- Assess characteristics of the rash (i.e., presence of papules, vesicles, nodules) affecting the perianal and perineal areas.
In most patients, the rash is caused by irritant contact dermatitis resulting from the moist environment in the diaper area, and treatment can be initiated without further diagnostics.
If symptoms persist or worsen despite initial treatment, or if the patient has symptoms that suggest a different condition, further diagnostics guided by history and physical examination findings are appropriate.
- Candidiasis: KOH preparation, fungal culture of the skin
- Bacterial infection: bacterial culture for S. aureus or group A Streptococcus
- Skin biopsy: atypical rashes and/or those that do not respond to conventional therapy
Chronic candidal diaper dermatitis in children should raise suspicion for diabetes mellitus type 1. In the absence of diabetes mellitus type 1, chronic and/or severe diaper dermatitis should raise suspicion for child neglect or abuse.