diaper dermatitis

WordNet

1. garment consisting of a folded cloth drawn up between the legs and fastened at the waist; worn by infants to catch excrement (同)nappy, napkin
2. a fabric (usually cotton or linen) with a distinctive woven pattern of small repeated figures
3. inflammation of the skin; skin becomes itchy and may develop blisters

PrepTutorEJDIC

1. 〈C〉《米》おしめ,おむつ(《英》nappy, napkin) / 〈U〉菱形模様;菱形地紋の麻布(タオル・ナプキン用) / 〈赤ん坊〉‘に'おむつを当てる
2. 皮膚炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/10/13 23:12:51」(JST)

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Diaper rash
diaper dermatitis, napkin dermatitis" diaper rash, nappy rash
Benign diaper rash
Classification and external resources
Specialty	dermatology
ICD-10	L22
ICD-9-CM	691.0
DiseasesDB	23119
MedlinePlus	000964
eMedicine	ped/2755
MeSH	D003963

Irritant diaper dermatitis, is a generic term applied to skin rashes in the diaper area that are caused by various skin disorders and/or irritants.

Generic rash or irritant diaper dermatitis (IDD) is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, with the skin folds spared.

Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i.e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border.

It is usually considered a form of irritant contact dermatitis. Despite the word "diaper" in the name, the dermatitis is not due to the diaper itself, but to the materials trapped by the diaper (usually feces). Allergic contact dermatitis has also been suggested, but there is little evidence for this etiology.

The term diaper candidiasis is used when a fungal origin is identified. The distinction is critical, because the treatment (antifungals) is completely different.

Causes

Irritant diaper dermatitis develops when skin is exposed to prolonged wetness, increased skin pH caused by urine and feces, and resulting breakdown of the stratum corneum, or outermost layer of the skin. This may be due to diarrhea, frequent stools, tight diapers, overexposure to ammonia, or allergic reactions. In adults, the stratum corneum is composed of 25 to 30 layers of flattened dead keratinocytes, which are continuously shed and replaced from below. These dead cells are interlaid with lipids secreted by the stratum granulosum just underneath, which help to make this layer of the skin a waterproof barrier. The stratum corneum's function is to reduce water loss, repel water, protect deeper layers of the skin from injury, and to repel microbial invasion of the skin. In infants, this layer of the skin is much thinner and more easily disrupted.

Diaper rash can be considered a form of intertrigo, that is an area of skin irritation that occurs when there is excessive moisture between two opposing skin surfaces. The key is the excessive moisture. As such, anything that keeps the skin surfaces dry will end the problem.

Urine

Cloth diaper

Although wetness alone has the effect of macerating the skin, softening the stratum corneum, and greatly increasing susceptibility to friction injury, urine has an additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only a mild skin irritant, when urea breaks down in the presence of fecal urease it increases pH because ammonia is released, which in turn promotes the activity of fecal enzymes such as protease and lipase. These fecal enzymes increase the skin's hydration and permeability to bile salts which also act as skin irritants.

There is no detectable difference in rates of diaper rash in conventional disposable diaper wearers and reusable cloth diaper wearers. "Babies wearing superabsorbent disposable diapers with a central gelling material have fewer episodes of diaper dermatitis compared with their counterparts wearing cloth diapers. However, keep in mind that superabsorbent diapers contain dyes that were suspected to cause allergic contact dermatitis (ACD)." Whether wearing cloth or disposable diapers they should be changed frequently to prevent diaper rash, even if they don't feel wet. To reduce the incidence of diaper rash, disposable diapers have been engineered to pull moisture away from the baby's skin using synthetic non-biodegradable gel. Today, cloth diapers use newly available superabsorbent microfiber cloth placed in a pocket with a layer of light permeable material that contacts the skin. This design serves to pull moisture away from the skin in to the microfiber cloth. This technology is used in most major pocket cloth diapers brands today.

Diet

The interaction between fecal enzyme activity and IDD explains the observation that infant diet and diaper rash are linked because fecal enzymes are in turn affected by diet. Breast-fed babies, for example, have a lower incidence of diaper rash, possibly because their stools have higher pH and lower enzymatic activity. Diaper rash is also most likely to be diagnosed in infants 8–12 months old, perhaps in response to an increase in eating solid foods and dietary changes around that age that affect fecal composition. Any time an infant’s diet undergoes a significant change (i.e. from breast milk to formula or from milk to solids) there appears to be an increased likelihood of diaper rash.

The link between feces and IDD is also apparent in the observation that infants are more susceptible to developing diaper rash after treating with antibiotics, which affect the intestinal microflora. Also, there is an increased incidence of diaper rash in infants who have suffered from diarrhea in the previous 48 hours, which may be because fecal enzymes such as lipase and protease are more active in feces which have passed rapidly through the gastrointestinal tract.

Differential diagnosis

Other rashes that occur in the diaper area include seborrhoeic dermatitis and atopic dermatitis. Both Seborrheic and Atopic dermatitis require individualized treatment; they are not the subject of this article.

• Seborrheic dermatitis, typified by oily, thick yellowish scales, is most commonly seen on the scalp (cradle cap) but can also appear in the inguinal folds.
• Atopic dermatitis, or eczema, is associated with allergic reaction, often hereditary. This class of rashes may appear anywhere on the body and is characterized by intense itchiness.

Secondary infections

The significance of secondary infection in IDD remains controversial. Atherton contends that, “Candida albicans can only be isolated from a minority of IDD cases; in many cases this is a reflection of antibiotic therapy. It has also been established that bacterial infection does not play a substantial part in the development of IDD.”(Atherton, 2004, p. 646).

However, there is little argument that once the stratum corneum has been damaged by a combination of physical and chemical factors, the skin is more vulnerable to secondary infections by bacteria and fungi. In analyzing swab samples at the perianal, inguinal and oral areas of 76 infants, Ferrazzini et al. (2003) found that colonization with Candida albicans was significantly more likely in children with symptomatic diaper rash than without. Staphylococcus aureus was also present more frequently in symptomatic than in healthy infants, but the difference was not statistically significant. A wide variety of other infections has been reported on occasion, including Proteus mirabilis, enterococci and Pseudomonas aeruginosa, but it appears that Candida is the most common opportunistic invader in diaper areas.

Although apparently healthy infants sometimes culture positive for Candida and other organisms without exhibiting any symptoms, there does seem to be a positive correlation between the severity of the diaper rash noted and the likelihood of secondary involvement (Ferrazzini et al., 2003; Gupta & Skinner, 2004; Wolf et al., 2001).

Treatments

The most effective treatment, although not the most practical one, is to discontinue use of diapers, allowing the affected skin to air out. Thorough drying of the skin before diapering is a good preventive measure because it is the excess moisture, either from urine and feces or from sweating, that sets the conditions for a diaper rash to occur. Various moisture-absorbing powders, such as talcum or starch, reduce moisture but may introduce other complications. Airborne powders of any sort can irritate lung tissue, and powders made from starchy plants (corn, arrowroot) provide food for fungi and are not recommended by the American Academy of Dermatology.

Another approach is to block moisture from reaching the skin, and commonly recommended remedies using this approach include oil-based protectants or barrier cream, various over-the-counter "diaper creams", petroleum jelly, dimethicone and other oils. Such sealants sometimes accomplish the opposite if the skin is not thoroughly dry, in which case they serve to seal the moisture inside the skin rather than outside.

Zinc oxide-based ointments are quite effective, especially in prevention, because they have both a drying and an astringent effect on the skin, being mildly antiseptic without causing irritation.

In persistent or especially bad rashes, an antifungal cream often has to be used. In cases that the rash is more of an irritation, a mild topical corticosteroid preparation, e.g. hydrocortisone cream, is used. As it is often difficult to tell a fungal infection apart from a mere skin irritation, many physicians prefer an corticosteroid-and-antifungal combination cream such as hydrocortisone/miconazole.

Some sources claim that diaper rash is more common with cloth diapers, yet others claim that the type of diaper makes no difference, but that cloth diapers can speed up the healing process. Others claim the material of the diaper is relevant insofar as it can wick and keep moisture away from the baby's skin. Possible treatments include minimizing diaper use, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.

See also

• Hand eczema
• List of cutaneous conditions

References

External links

• Diaper Rash Pictures (Hardin MD/Univ of Iowa)

UpToDate Contents

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• 1. おむつ皮膚炎diaper dermatitis [show details]
  …pediatric visits for diaper dermatitis, and the calculated risk of developing diaper dermatitis throughout childhood was one in four . In infants, the estimated prevalence of diaper dermatitis ranges from 7 to …
• 2. 小児のカンジダ症candida infections in children [show details]
  …Candida vulvovaginitis is discussed separately. Candida balanitis may occur as a component of diaper dermatitis in infants. It also may be acquired sexually in adolescents. Clinical features include white …
• 3. 学会が公開する診療ガイドラインのリンク：おむつ皮膚炎society guideline links diaper dermatitis [show details]
  …Links to related guidelines are provided separately. American Academy of Dermatology (AAD): Diaper rash – How to treat; National Institute for Health and Care Excellence (NICE): Clinical guideline…
• 4. 新生児におけるカンジダ感染症の臨床症状および診断clinical manifestations and diagnosis of candida infection in neonates [show details]
  …infants, candidal diaper dermatitis was a risk factor for developing systemic infection, which was usually heralded by a change in clinical status. Infants with candidal diaper dermatitis were also more likely …
• 5. 新生児におけるカンジダ感染の治療treatment of candida infection in neonates [show details]
  …categories of candidal infections in neonates: Noninvasive mucocutaneous candidiasis (eg, thrush, diaper dermatitis) Invasive infections (which can involve the bloodstream, urinary tract, central nervous system …

English Journal

• Modern diaper performance: construction, materials, and safety review.

• Dey S1, Kenneally D1, Odio M1, Hatzopoulos I1.
• International journal of dermatology.Int J Dermatol.2016 Jul;55 Suppl 1:18-20. doi: 10.1111/ijd.13333.
• A review of the literature on diapers and diaper rash reveals that many clinicians are unfamiliar with modern diaper construction and materials as well as diaper safety testing methods. Typical modern diapers do not contain ingredients of concern such as latex and disperse dyes, but use ingredients
• PMID 27311782

• Infections and skin diseases mimicking diaper dermatitis.

• Van Gysel D1.
• International journal of dermatology.Int J Dermatol.2016 Jul;55 Suppl 1:10-3. doi: 10.1111/ijd.13372.
• Diaper dermatitis is a common condition that often prompts parents to seek medical attention. Irritant diaper dermatitis is by far the most common cause, but numerous potentially serious diseases can present with changes of the skin in the diaper area. The differential diagnosis can include psoriasi
• PMID 27311780

Japanese Journal

• 乳児脂漏性皮膚炎・新生児痤瘡・汗疹・オムツ皮膚炎 (特集 これ1冊!こども皮膚病 : 診断と治療)

• デルマ (271), 1-7, 2018-06
• NAID 40021607112

• 新生児期の皮膚トラブル実態とその関連要因

• 日本助産学会誌 31(2), 111-119, 2017
• NAID 130006267727

Related Pictures

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★リンクテーブル★

リンク元	「おむつ皮膚炎」
関連記事	「diaper」

「おむつ皮膚炎」

　　[★]

英

diaper rash、diaper dermatitis

関

おむつかぶれ

「diaper」

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• n.

• ダイヤパー
• ダイヤパーのナプキン/タオル。月経帯、ナプキン。(赤ん坊の)おむつ
• 菱形などの幾何学模様、寄せ木模様