FeaturesPrevention, Treatment and Parent Education for Diaper Dermatitis
Section snippets
Objectives
Upon completion of this activity, the learner will be able to:
- 1.
Describe the prevalence of diaper dermatitis among infants in the United States.
- 2.
Describe the pathophysiology of diaper dermatitis.
- 3.
List the recommended prevention and treatment strategies for diaper dermatitis.
- 4.
Describe targeted parent education for the prevention and treatment of diaper dermatitis.
- 5.
Discuss nursing practice implications in the prevention and treatment of diaper dermatitis.
INTRODUCTION
Diaper dermatitis is a common cutaneous condition characterized by an acute inflammatory eruption of the skin in the diaper area of an infant. Although this condition is relatively common, it can cause considerable pain and stress for infants and can be troublesome for their caregivers (Blume‐Peytavi et al., 2014).
PREVALENCE
It is difficult to determine the actual prevalence of diaper dermatitis in the general population due to inconsistencies among published studies and highly variable results, but it is estimated that the prevalence of diaper dermatitis in the general population is between 7 percent and 35 percent (Boiko, 1999; Gupta & Skinner, 2004; Rowe, McCall, & Kent, 2008). It has also been reported that the prevalence among hospitalized infants and children ranges from 17 percent to 43 percent (McLane,
TYPES OF DIAPER DERMATITIS
The three most common types of diaper dermatitis include chaffing dermatitis, irritant contact dermatitis and diaper candidiasis (Paller & Mancini, 2011). Diaper dermatitis is usually related to the presence of irritants on the skin, such as moisture from urine and feces, fecal enzymes, diaper materials and cleansing agents, as well as friction caused by the diaper itself (Humphrey, Bergman, & Au, 2006; Wolf, Wolf, Tuzun, & Tuzun, 2000). Although irritant contact dermatitis is the most common
PHYSIOLOGY OF INFANT SKIN
To understand the development of diaper dermatitis in an infant, it is important to appreciate the differences in skin between adults, full‐term infants and premature infants. Human skin is a complex tissue that assists with thermoregulation, prevents insensible water loss, acts as a sensory organ and functions as a barrier by providing protection from physical, chemical and biologic threats. It consists of three major layers—the stratum corneum, epidermis and dermis. The epidermal barrier is a
PATHOPHYSIOLOGY OF DIAPER DERMATITIS
The development of irritant contact diaper dermatitis is multifactorial. The skin in the diaper area is predisposed to irritation by overhydration or maceration of the stratum corneum and epidermis, the presence of irritants, such as urine or stool, friction on the skin and the presence of a high skin pH (Atherton, 2001). The presence of urine can lead to overhydration of the skin, making the skin surface more fragile and increasing the permeability of the skin by irritants (Atherton, 2001;
CLINICAL PRESENTATION
Chaffing or frictional dermatitis is the most widespread form of mild diaper dermatitis commonly affecting most infants at some point in time. It presents in areas where friction from the diaper is most prevalent, including the inner surface of the thighs, buttocks, abdomen, and the surface of the genital areas (Paller & Mancini, 2011). It presents as mild redness in the affected area and resolves fairly quickly on its own with frequent diaper changes, ensuring the diaper is not too tight, and
ASSESSMENT
Diaper dermatitis is diagnosed by the appearance of the rash and by excluding other potential causes. In addition to a physical assessment, a thorough history must be obtained, including duration of the presenting rash, symptoms, such as pain and itchiness, hygiene practices and cleansing routine, type of diaper used, exposure to potential irritants, trauma to the skin and recent antibiotic use that might predispose an infant to other causes of diaper dermatitis (Lawton, 2014; Shin, 2014).
DIFFERENTIAL DIAGNOSES
There are a wide variety of conditions that can present as an inflamed area of skin in the diaper area. A wider range of differential diagnoses should be considered when diaper dermatitis fails to respond to basic treatment approaches or when there are additional symptoms that require further investigation. Differential diagnoses can be divided into categories, including inflammatory conditions, infectious conditions, and other potential diagnoses.
Diaper dermatitis is diagnosed by the
INFLAMMATORY CONDITIONS
Seborrheic dermatitis is a common cause of dermatitis in infancy that develops around the third to fourth week of life. It presents as asymptomatic, well‐defined erythema, with characteristic salmon‐colored, greasy plaques with yellow scales found on the scalp, cheeks, chest, body creases and diaper areas (Ravanfar, Wallace, & Pace, 2012; Shin, 2014). This condition may require treatment with low‐dose topical corticosteroid as prescribed by a health care provider (Coughlin, Eichenfield, &
INFECTIOUS CONDITIONS
Bacterial infections can present in a variety of forms, including impetigo and bacterial folliculitis. Streptococcal and staphylococcal infections account for the highest number of bacterial diaper dermatitis isolates (Brook, 1992). Impetigo, caused by staphylococcus or streptococcus infection, presents as superficial vesicles or flaccid bullae that eventually develop a honey colored crust (Scheinfeld, 2005; Shin, 2014). Bacterial folliculitis, often caused by staphylococcus aureus, can
OTHER DIFFERENTIAL DIAGNOSES
Nutritional deficiencies, such as zinc deficiency, can present similarly to diaper dermatitis. Acrodermatitis enteropathica, an autosomal recessive condition that leads to zinc malabsorption, presents as sharply demarcated, erythematous plaques, papules and erosion in the periorificial areas, on distal portions of the extremities and in the diaper area (Coughlin et al., 2014; Ravanfar et al., 2012; Shin, 2014). Dermatitis, alopecia and diarrhea are the classic symptoms of this disease. Acquired
NONPHARMACOLOGIC PREVENTION AND TREATMENT
An abundance of literature that supports current best practices in the treatment and prevention of diaper dermatitis has been published, including the most recent evidence‐based clinical practice guideline on neonatal skin care from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN, 2013). The basic techniques for prevention and treatment are quite similar (Atherton, 2001). Although the key to diaper dermatitis is prevention, once it develops, the overall goal is to
“ABCDE” APPROACH
Practical nonpharmacologic solutions for both prevention and treatment are easily summarized into the “ABCDE” approach that includes air, barrier, cleansing, diapering and education (Boiko, 1999; see Box 4).
PHARMACOLOGIC TREATMENT AND POTENTIAL SIDE EFFECTS
Pharmacological treatment when required includes antibacterial, antifungal and topical corticosteroid therapy. For diaper dermatitis caused by C. albicans, the goal of treatment is both to treat the infection and prevent further skin breakdown. The most commonly prescribed topic antifungal agent for treatment of diaper dermatitis complicated by C. albicans is nystatin (Ward et al., 2000). To facilitate adequate treatment of the fungal infection while still providing barrier protection, Heimall
COMPLICATIONS OF UNTREATED DIAPER DERMATITIS
Complications from diaper dermatitis are rare as the condition is easily treatable with good skin care practices, barrier creams and treatment of underlying infections. In rare instances, or if diaper dermatitis is left untreated, complications including increasing pain, increasing severity of skin breakdown and bacterial and fungal super infections can occur (Shin, 2014). One example is Jacquet's erosive diaper dermatitis, a severe form of diaper dermatitis that can present with severe
CONCLUSION
Diaper dermatitis is a common condition that can cause considerable pain and stress for infants and be troublesome for their caregivers. Differential diagnosis is important, as is identifying any potential underlying conditions, such as a bacterial or viral infection. Nurses play a pivotal role in helping families understand the risk factors for diaper dermatitis and how to prevent it through appropriate diaper hygiene practice. NWH
Post‐Test Questions
Instructions: To receive contact hours for this learning activity, please complete the online post‐test and participant feedback form at http://JournalsCNE.awhonn.org. CNE for this activity is available online only; written tests submitted to AWHONN will not be accepted.
- 1.
What is the estimated range of prevalence of diaper dermatitis?
- a.
2 percent to 14 percent
- b.
7 percent to 35 percent
- c.
10 percent to 50 percent
- a.
- 2.
Which layer of the skin is the protective barrier to physical, chemical and biologic agents?
- a.
Lisa Merrill, MN, RN, is a clinical nurse specialist at Women's Hospital Health Sciences Center, in Winnipeg, Manitoba, Canada. The author and planners of this activity report no conflicts of interest or relevant financial relationships. This learning activity was supported through an educational grant from Kimberly‐Clark/Huggies®.
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Cited by (28)
Effects of argan spinosa oil in the treatment of diaper dermatitis in infants and toddlers: A quasi-experimental study
2023, Journal of Taibah University Medical SciencesEnd-of-life management of single-use baby diapers: Analysis of technical, health and environment aspects
2022, Science of the Total EnvironmentCitation Excerpt :Thus, a diaper should be changed at least every 1 to 3 h during the day and at least once per night. Even if the diaper is only soiled with urine cleansing with warm water or a gentle diaper wipe to remove irritants from the skin is imperative (Merrill, 2015). The continuous improvement of SAP's absorbent properties makes it possible to change diapers less frequently.
Environmental problems and health risks with disposable baby diapers: Monitoring of toxic compounds by application of analytical techniques and need of education
2021, TrAC - Trends in Analytical ChemistryCitation Excerpt :Severity of the skin irritation can be wide in scale from mild dryness, a few scattered papules to very intense redness or even edema, severe desquamation, erosion and ulceration. Common types of diaper dermatitis are chaffing dermatitis, irritant contact dermatitis and diaper candidiasis [43–45]. Good hygiene practices and regular diaper changes can reduce the frequency of developing nappy rash, but cannot eliminate it [46,47].
Art of prevention: The importance of proper diapering practices
2019, International Journal of Women's DermatologyCitation Excerpt :A thick coat should be applied at each diaper change after gently removing stool or other contaminants. Noncontaminated residual barrier cream does not have to be completely removed at each change (Merrill, 2015). Cornstarch may be used to reduce moisture and friction in the diaper area but should be used with care to prevent inhalation.
Lisa Merrill, MN, RN, is a clinical nurse specialist at Women's Hospital Health Sciences Center, in Winnipeg, Manitoba, Canada. The author and planners of this activity report no conflicts of interest or relevant financial relationships. This learning activity was supported through an educational grant from Kimberly‐Clark/Huggies®.