Diaper rash
Napkin rash is also known as ammonical dermatitis. It is a specific form of irritant dermatitis. It occurs due to irritation from ammonia, as a result of prolonged wearing of wet napkins. Sometimes the rash is caused by fungal infection, at other time, there is mixture of both. Other possibility of rashes in the napkin area is seborrhoeic dermatitis.
Usually, the child will present as erythema and umbilicated pustules over the genital area and perenium. In severe case, there will be ulceration of the perenium and sometimes the genitalia. Irritant rash usually occur sparingly at the whole perenium with the spare of the skin folds (which have less exposure to the urine or ammonia). As a contrary, candidal infection will be concentrates at these areas. Sometimes, it is difficult to differentiate between this two. The presence of discrete satellite lesions or involvement of the flexures is suggestive of monilial infection. In babies with loose stool, there is often perianal erythema, or perianal excoriation.
Prevention is always the best treatment. Napkins should be changed frequently. If possible care taker should make sure that the perenium is dry before put the baby on napkin again. In simple napkin rash, exposure of the perenium (with adequate ventilation) and a protective barrier cream is all that is required. We should always consider fungal infection (e.g.: monilial infection) if the rash is persistent and does not respond to simple treatment. It is also important to consider poor parenting or neglect in babies with persistent ammonical rash. Seborrhoeic dermatitis often requires the application of a weak steroid cream.
Reference:
- Graham Davis et al. Clinical Paediatricsand Child Health. 2001. W.B. Saunders.
- Paediatrics colour book. 1999.
Tags: ammonical dermatitis, diaper ras, monilial infection
Technorati Tags: ammonical dermatitis, diaper ras, monilial infection
