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Diaper dermatitis

Last updated: February 14, 2023

Summarytoggle arrow icon

Diaper dermatitis refers to various rashes affecting the perineal and perianal areas during diaper use. The most common cause is irritant contact dermatitis, which typically manifests with papules, plaques, and patches, sometimes with maceration or erosion. Other common causes included allergic contact dermatitis and infection. Diagnosis is initially based on clinical evaluation, and treatment of the suspected underlying cause can usually be initiated without further diagnostics. If symptoms worsen despite initial therapy, further diagnostics (e.g., bacterial culture, skin biopsy) guided by history and physical examination findings should be performed.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Overviewtoggle arrow icon

Overview of diaper dermatitis

Condition Etiology Characteristics of the rash Treatment
Diaper-related Irritant contact dermatitis (most common cause) [1]
  • Increased moisture
  • Irritation due to prolonged exposure to urine and feces
  • Diaper soaps, detergents
  • Lower stool pH (e.g., in nonbreastfed infants)
  • ABCDE approach [1]
    • Air: diaper-free periods to dry the skin
    • Barrier: cream or ointment (e.g., zinc oxide, lanolin) to protect the skin
    • Clean: keep the skin clean
    • Diaper: frequent diaper changes to maintain dryness
    • Education: explain the treatment plan to caregivers
  • Low-potency topical corticosteroids for persistent symptoms
Allergic contact dermatitis
  • Personal care products (e.g., perfumes, soaps, cosmetics)
Candidiasis
Non-diaper-related Seborrheic dermatitis
  • Unknown; may be associated with Malassezia spp.
Bacterial infection Perianal streptococcal dermatitis
Impetigo
Enterobiasis
Psoriasis

Diagnosticstoggle arrow icon

General

The diagnosis of diaper dermatitis is based on clinical evaluation.

  • Obtain a comprehensive clinical history.
  • Assess characteristics of the rash (i.e., presence of papules, vesicles, nodules) affecting the perianal and perineal areas.

In most patients, the rash is caused by irritant contact dermatitis resulting from the moist environment in the diaper area, and treatment can be initiated without further diagnostics.

Further diagnostics

If symptoms persist or worsen despite initial treatment, or if the patient has symptoms that suggest a different condition, further diagnostics guided by history and physical examination findings are appropriate.

Chronic candidal diaper dermatitis in children should raise suspicion for diabetes mellitus type 1. In the absence of diabetes mellitus type 1, chronic and/or severe diaper dermatitis should raise suspicion for child neglect or abuse.

Differential diagnosestoggle arrow icon

Referencestoggle arrow icon

  1. Klunk C, Domingues E, Wiss K. An update on diaper dermatitis.. Clin Dermatol. 2014; 32 (4): p.477-87.doi: 10.1016/j.clindermatol.2014.02.003 . | Open in Read by QxMD

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer