Many parents face such a problem as diaper dermatitis in children of the first year of life, that is, inflammation of the skin of the buttocks and folds of the inguinal region.
This is what is commonly called diaper rash, but, in fact, is its consequence - diaper erythema or rash. And if, according to ICD-10, the code of diaper dermatitis is L22, then the code for erythematous intertrigo is L30.4.
Light diaper dermatitis develops in almost half of children from birth to the year, and it accounts for at least 20-25% of all diagnosed dermatitis among children of this age.
This lesion of the skin, as noted by domestic pediatricians, most often occurs in infants after six to seven months. However, as practice shows, diaper erythema with a rash in the perianal area can develop in newborns - that is, at the age of one or two months.
Causes of the diaper dermatitis
Dermatologists refer to such major causes of diaper dermatitis in infants as prolonged over-moistening of the skin (in the absence of air) and its constant contact with urine containing salts, uric and hippuric acids, and urea, which breaks down with the release of ammonia. Fecal enzymes also cause irritation, and bacteria, usually present in feces, can increase urea degradation by the release of urease, which leads to an alkaline pH, which further irritates the skin.
Also, irritation arises from the mechanical damage to the covering epithelium when rubbing the skin with diapers or clothing (especially synthetic).
Risk factors for the appearance of diaper rash in the inguinal and gluteal region and the development of diaper dermatitis consist in the untimely change of wet diapers and the violation of the basic rules of hygiene in the care of the skin of the child after urination and bowel movement. An intestinal disorder with diarrhea also increases the risk of skin irritation of this localization.
In addition, in children who are fed with breast-milk substitutes, the development of diaper dermatitis is more frequent due to a higher content of enzymes in the feces. Although, as you know, the acidity of the stool during breastfeeding is significantly higher than in the case of artificial feeding, and its frequency during the newborn period is twice the number of emptying in infants.
Diaper dermatitis in adults - contact urinary dermatitis - occurs in bedridden patients (especially the elderly) with loss of control of urination and defecation.
The pathogenesis of diaper dermatitis in infants is very simple: at this age the child's skin can not yet withstand the external aggressive effects due to the weakness of the protective functions of the epidermis.
In the first months of life, the skin and its horny layer are very thin and have an increased hydrophilicity; the density of the epidermis is inadequate due to the lack of a strong connection with the dermis. The process of forming the epidermal basement membrane over the loose subcutaneous tissue continues, in which there is a lot of moisture, but there are almost no collagen and elastin fibers. And the sebaceous glands of the skin - despite their sufficient number and development - do not yet provide the fatty protective barrier (hydrolipid mantle) of the skin of the body.
In addition, there is no acidic mantle of the skin, because instead of skin pH at 5.5, the skin of an infant during the first two months after birth is between 6.2-6.8. All this and causes the vulnerability of the skin in children up to a year to various irritating factors.
Symptoms of the diaper dermatitis
The first signs of skin irritation are manifested by its reddening (erythema), which can be continuous or chagovar with localization in the buttocks and groin, on the inner thighs and around the external genitalia.
If the process does not go farther than the first stage of the inflammatory skin reaction (thanks to the measures taken), then this is considered an easy form of diaper dermatitis. But this pathology has two more stages (forms).
Symptoms of diaper dermatitis of the second stage (middle form) - are manifested by more intense reddening and rashes in the form of small papules or pustules with exudate. If their integrity is compromised and the exudate and intercellular fluid exit, mocculation (maceration zones) and small focal erosions appear.
The third stage (severe form) of the inflammatory process is considered to be a significant expansion of the affected areas and the appearance of puffiness and hemorrhagic ulceration. Some dermatologists call this form Jacquet's erosive diaper dermatitis.
In addition to skin symptoms, the child is troubled by itching, which is manifested by anxiety, crying, disturbed sleep and feeding.
In principle, the same skin symptoms manifested and diaper dermatitis in adults.
Complications and consequences
To diaper erythema can easily join any infection - bacterial or fungal. If the areas of the affected skin of the child are infected with strepto- or staphylococci, then complication develops such as bacterial diaper dermatitis, which is characterized by subfebrile body temperature, and the formation of purulent pustules, and then purulent crusts and extensive erosion, that is, the development of the clinical picture of staphylococcal bullous) impetigo.
And when the skin is affected by the Candida fungus, and around the affected areas the skin begins to peel, candidiasis diaper dermatitis is diagnosed. In both cases, antibacterial or antifungal therapy is required.
Diagnostics of the diaper dermatitis
Typically, the diagnosis of this lesion of the skin of infants is based on the available symptoms.
In severe cases, a blood test (general clinical) may be required.
Differential diagnosis is designed to distinguish diaper dermatitis from allergic dermatitis, for example, allergies to diapers, or atopic dermatitis; bullous impetigo; perianal streptococcal dermatitis (which can occur with diarrhea in newborns); enteropathic acrodermatitis (due to congenital deficiency of zinc in the body), congenital syphilis, etc.
Prescribe the treatment of diaper dermatitis should the doctor, since it depends on the stage (form) of the pathology. The main components of therapy - compliance with the rules of hygienic care. So, with a mild form of diaper erythema, it's enough to change wet and dirty diapers in time and after each urination or feces wash the inguinal and gluteal region of the body with warm water with baby soap and then dry it well by blotting. Pediatricians are also advised to leave the baby naked for several minutes (at room temperature not below + 22-25 ° C): these air baths ensure the evaporation of moisture residues from the skin (especial from the folds in the groin and on the inner thighs). Dry skin should be oiled with mineral or vegetable oil. Such oils are recommended for diaper dermatitis, as: vaseline, stone (almond), sea-buckthorn. You can also use a baby cream with an extract of chamomile or string.
To dry the wet areas of the skin, the use of powders with diaper dermatitis, in which zinc oxide is present, is practiced: it not only dries the skin, but also fights against infection. With the same purpose, traditionally used zelenka with diaper dermatitis (once a day), as well as zinc ointment - two or three times a day.
But the cream Cinovit (with zinc pyrithione and a derivative of glycyrrhizic acid) contains more exfoliating lactic acid and oils and is designed to fight acne and acne. Do not use the product for up to a year.
One of the best ways to get rid of diaper erythema is the cream with dexpanthenol Bepanten (other trade names are Dexpanthenol, D-Panthenol, Pantestine, Pantoderm).
An effective agent is Sudocrem, which includes zinc oxide and benzyl compounds with antibacterial and antifungal properties. But with a damp skin this cream should not be used, since after its application a film is formed.
Medicines for external use with antibiotics and antimycotic components are necessary if bacterial or fungal infection is attached to diaper dermatitis. And they are used only for the prescription of a dermatologist. For example, to treat candidal diaper dermatitis, it is best to apply 1% cream Clotrimazole (Lotrimin, Oronazol), which is applied to the affected skin three times a day until the rash disappears, and then for at least two more weeks - once a day.
Bacterial diaper dermatitis is successfully treated with Levomecol (with chloramphenicol and methyluracil) - once or twice a day. The drug Baneocin - thanks to the presence of antibiotics, neomycin and bacitracin copes well with the swollen skin inflammations. But neomycin, absorbed into the skin of an infant, can cause toxic effects on the kidneys and reduce hearing. Therefore, even adults can not be applied to large areas of the skin. The same applies to Baneoecin in powder form, which is used as a powder for bacterial diaper dermatitis in adults.
In the pimafukort ointment, the active substances are the antibiotics neomycin and natamycin, as well as hydrocortisone. Hydrocortisone is well absorbed by the skin, and in young children, the degree of absorption is even higher, which increases the risk of its negative systemic effects in the form of a decrease in the functions of the pituitary and adrenal glands, the development of hypercorticism, the excretion of calcium from the body and slowing growth. The use of GCS can lead not only to the development of reactive dermatosis, the violation of trophic skin and its atrophy, but also to the activation of infection. In addition, the ointment contains neomycin, the side effect of which has already been mentioned. This ointment, according to the official instruction, is not prescribed for children up to a year.
Triderm Ointment contains a potent corticosteroid betamethasone (relieves inflammation and itching), antibiotic gentamicin and clodrimazole, acting on a candidiasis infection. Among its contraindications - dermatoses (including diaper) in children of the first year of life.
Ointment Acryderm, except for betamethasone, contains antibiotic gentamicin and children are contraindicated for up to a year.
Advantan (0.1% ointment, cream, emulsion) also refers to topical corticosteroids, since its active ingredient is potent GCS methylprednisolone. But, as indicated in the instruction, its application (once a day) to children with diaper dermatitis without maceration is permissible - after four months.
It should be borne in mind that foreign pediatricians are not prescribed corticosteroids for children under two years of age. Our doctors consider possible children up to a year external use of 1% hydrocortisone, but in small areas of the skin.
Among the alternative remedies for diaper dermatitis is the decoction of bay leaves (two leaves per 200 ml of water, boiled for about 10 minutes), which treat the affected areas. Suitable in such cases are infusions or decoctions of oak bark and birch leaves.
Also - with a slight skin hyperemia - you can treat herbs: wash the buttocks and inguinal folds with decoctions of chamomile, sequins, sage, marigold, plantain (two to three tablespoons of a dry plant per liter of water).
Undoubtedly the benefits of bathing babies with the addition of herbal decoctions in the bath, and this is a simple and proven physiotherapy treatment at home for many generations.
The main prevention of diaper dermatitis is the proper care of the child's skin and hygiene. "Save" on diapers, taking into account the causes of development of irritation and skin inflammation, is unacceptable.
Parents should not worry: the prognosis for the development of diaper dermatitis is favorable and for the health of the baby, there are no threats.
Last update: 25.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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