BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN

FAKULTAS KEDOKTERAN
UNIVERSITAS HASANUDIN

DIAPER RASH

Oleh:
Stanly Pieter Thenu (2008-83-047)
Chresta D. Illintutu (2008-83-048
Jeane P. Andries (2008-83-035)
Pembimbing:
Dr. Dinie Ramdhani K
Konsulen:
Dr. Safruddin Amin, Sp.KK(K), MARS
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN
UNIVERSITAS PATTIMURA
1
AMBON
2014

Introduction

Diaper Rash/Diaper Dermatitis/napkin dermatitis:

Inflammatory eruption of the napkin area

highly prevalent condition in infancy, although the

reported prevalence varies greatly between different
studies.

Jordan et al.1 reported that half of children of age 1 20

months had nappy rash

highest reported prevalence of diaper dermatitis is in the

9 12-month age group

Introduction

Diaper dermatitis

is the result of progressive barrier compromise and

is characterized by dryness/scaling, aberrant

desquamation and erythema.

When the stratum corneum is exposed to prolonged

wetness in an occlusive nappy environment

Introduction

The following factors need to be considered in any

etiology:

Maceration by water

Excessive wetness has several effects on the stratum corneum

Prolonged occlusion of the skin can itself produce erythema,

particularly if water is kept in contact with the skin surface

Friction

Urine

Feces

The combination of these factors breakdown of the

stratum corneum predisposes the skin to opportunistic
infection by faecal microbes diaper dermatitis

Introduction

Clinical manifestasion

onset : during the third to the 12th week (most often),

peak prevalence : between the seventh and 12th months.

The most common form primary irritant napkin

dermatitis

confluent erythema of the convex surfaces in closest contact

with the napkin

that is the buttocks, the genitalia, the lower abdomen and

pubic area, and the upper thighs.

The deeper parts of the groin flexures are generally spared.

Introduction

Clinical Manifestation

erosive form (Jacquets dermatitis) : small vesicles and

erosions, shallow, round ulcers with raised crater-like
edges.

variants of primary irritant napkin dermatitis secondary

invasion by C. albicans.

secondary invasion by C. albicans

erythema may be more intense,

will no longer spare the deeper parts of the flexural folds.

Introduction

Treatment:

Prevention is the best treatment

emolient

Zinc oxide

Topical corticosteroid

Anti-fungi

Diagnosis

History

High prevalence between 6 and 12 month

history concerning skin & diaper care predisposing

factors

history of present illness,

associated symptoms, & physical examination a clinical

diagnosis of irritant contact diaper dermatitis

Other condition :

mouth must be inspected for thrush

skin and nails examined for other lesions

Anamnesis

A complete history includes gestational and birth history

family history

Exposures during pregnancy

medications,

illicit drugs, and

infectious diseases such as varicella and

sexually transmitted diseases

Physical examintation

Irritant diaper dermatitis (Classic findings)

redness and scaling or maceration of the groin with sparing of

the skin creases

erythematous, moist, and sometimes scaly patches on the

convexities area (genitalia and buttocks

areas in closest contact with the diaper.

Shallow erosions sometimes.

Diaper rash in
convex area

Candida secondary infection

second most common type

bright red erythematous,

moist papules,

patches, and plaques that tend to involve body folds

seborrheic dermatitis ,

confluent erythema with greasy, white-yellow scale,

on the scalp (cradle cap)

intertriginous areas are often moist or macerated

Jacquets dermatitis

well-demarcated,

punched-out ulcers

erosions with elevated borders.

A)

diaper dermatitis seboroik.

B)

Jacquets diaper dermatitis.

Additional Exam

KOH candida

infeksi herpes Tzanck

Virus direct fluorescent antibody (DFA)

Algorithm diagnosis diaper dermatitis

Treatment

Prevention is the best treatment

Elements of successful treatment include the following:

1.

Attention to the napkins

Disposable napkins

Continuous administration of emollient from certain

disposable napkins.

Frequency of napkin changes

Care of washable napkins

2.

Routine skin care in the napkin area.

3.

Specific therapy

Specific therapy

Topical corticosteroid

Hidrokortison 1%

Strong corticosteroid should be avoided

Covered by emollient

Antifungal

Nystatin

Clotrimazone, Ketokonazole, Miconazone

Covered by emollient

Consider adding hydrocortisone 1%

Topical and systemic Antibiotic

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