Diaper irritant contact dermatitis - Anogenital in
There have been several reports in the literature of laxative use in infants leading to a severe irritant dermatitis. Laxative-induced diarrhea contained and occluded by a diaper can cause bullae and erosions.
Childhood physical and sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from other benign skin conditions. Perineal irritation and erythema are common causes for concern but are most likely due to irritant contact dermatitis (often caused by diapers), seborrheic dermatitis, poor hygiene, candidal lesions, and excoriation secondary to pruritus. However, severe diaper dermatitis may be a sign of physical neglect if associated with other risk factors. Additional physical findings increasing the possibility of abuse include marked subcutaneous wasting, xerosis due to chronic avitaminosis, and poor hygiene, often with associated pediculosis capitis.
Related topics: Jacquet erosive diaper dermatitis, Diaper dermatitis candidiasis
L22 – Diaper dermatitis
91487003 – Diaper rash
Differential Diagnosis & Pitfalls
Alternative causes include atopic and seborrheic dermatitis (look for rash at distant sites such as the face and scalp for seborrheic dermatitis and flexural regions for atopic dermatitis).
- Allergic contact dermatitis, particularly due to dyes in diapers or ingredients such as methylisothiazolinone in baby wipes.
- Psoriasis will present as well-demarcated pink plaques that do not spare the skin folds and may be associated with perianal streptococcal infections.
- Granuloma gluteale infantum (nodules are present)
- Hereditary acrodermatitis enteropathica, acquired zinc deficiency, and other nutritional deficiencies should be considered in persistent conditions.
- Langerhans cell histiocytosis (LCH) is a crucial differential diagnosis not to overlook. LCH lesions are petechial papules, often in the skin folds, that do not respond to standard therapies for diaper dermatitis.
- Perianal streptococcal infection
- Human papillomavirus
- Herpes simplex virus
- Bullous impetigo
- Molluscum contagiosum
- Hand-foot-and-mouth disease
- Nonaccidental trauma (see physical child abuse and sexual child abuse)
- Kawasaki disease
- Cystic fibrosis
- Lichen sclerosus
- Congenital syphilis
- Hyperimmunoglobulinemia E syndrome
- Methylmalonic acidemia
Drug Reaction Data