Irritant diaper dermatitis is a term for dermatitis caused by the occlusion, moisture, and friction produced by diapers or training pants. Once the skin barrier is compromised by this environment, secondary factors such as urinary ammonia, increased urine pH, fecal proteases and lipases, Candida albicans, bacterial overgrowth, and detergent soaps exacerbate the dermatitis.
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.
Related topics: Jacquet erosive diaper dermatitis, Diaper dermatitis candidiasis
Diaper irritant contact dermatitis
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Synopsis
Codes
ICD10CM:
L22 – Diaper dermatitis
SNOMEDCT:
91487003 – Diaper rash
L22 – Diaper dermatitis
SNOMEDCT:
91487003 – Diaper rash
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
There are many causes of diaper-area rashes. The most common alternative diagnosis in this region is Candida-induced diaper dermatitis. Irritant dermatitis presents with confluent redness in diaper-contact regions with relative sparing in skin folds. Candida presents with pustules and discrete red papules, often found within the folds. In Candida infections, satellite lesions – red papules slightly removed from the main cluster of papules and plaques – are clues to the diagnosis.
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).
Also consider:
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).
Also consider:
- 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
- Scabies
- Nonaccidental trauma (see physical child abuse and sexual child abuse)
- Kawasaki disease
- Cystic fibrosis
- Lichen sclerosus
- Congenital syphilis
- Hyperimmunoglobulinemia E syndrome
- Methylmalonic acidemia
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:11/19/2017
Last Updated:01/16/2020
Last Updated:01/16/2020
Patient Information for Diaper irritant contact dermatitis
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Diaper irritant contact dermatitis
See also in: Anogenital