Diaper rash (U.S.) or nappy rash (UK), is a generic term applied to skin rashes in the diaper area that are caused by a various skin disorders and/or irritants. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // L00-L99 - Diseases of the skin and subcutaneous tissue (L00-L08) Infections of the skin and subcutaneous tissue (L00) Staphylococcal scalded skin syndrome (L01) Impetigo (L02) Cutaneous abscess, furuncle and carbuncle (L03) Cellulitis (L04) Acute lymphadenitis (L05) Pilonidal cyst (L08) Other local infections of skin and subcutaneous tissue (L081) Erythrasma... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... For other uses, see American English (disambiguation). ... Beyond overall skin structure, refer below to: See-also. ... It has been suggested that this article or section be merged with Training pants. ...

Generic rash or irritant diaper dermatitis (IDD) is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, with the skin folds spared. Erythema is an abnormal redness of the skin caused by capillary congestion. ... Skin folds are areas of skin where it folds. ...

Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i.e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border (Hockenberry, 2003). Dermatitis is a blanket term literally meaning inflammation of the skin. It is usually used to refer to eczema, which is also known as Dermatitis eczema. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Divisions Chytridiomycota Zygomycota Ascomycota Basidiomycota The Fungi (singular: fungus) are a large group of organisms ranked as a kingdom within the Domain Eukaryota. ... Erythema is an abnormal redness of the skin caused by capillary congestion. ... An abscess is a collection of pus collected in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e. ...

Differential diagnosis

Other rashes that occur in the diaper area include Seborrheic dermatitis and Atopic dermatitis. Both Seborrheic and Atopic dermatitis require individualized treatment; they are not the subject of this article. Seborrhoeic dermatitis is a skin disorder affecting the scalp, face and trunk causing scaly, flaky, itchy, red skin. ...

• Seborrheic dermatitis, typified by oily, thick yellowish scales, is most commonly seen on the scalp (cradle cap) but can also appear in the inguinal folds.
• Atopic dermatitis, or eczema, is associated with allergic reaction, often hereditary. This class of rashes may appear anywhere on the body and is characterized by intense itchiness.

The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and posteriorly. ... An infant with Cradle Cap Close up image of Cradle Cap Cradle Cap (Infantile seborrhoeic dermatitis, or crusta lactea, milk crust, honeycomb disease; croûte de lait, eczéma infantile, dermatite atopique infantile (French); ne shqip njihet si - rrjebull ose rrjebulla (Albanian); crosta lattea (Italian); and σμηγματόρροια του τριχωτού της κεφαλής των νεογνών (Greek)) is a patchy... For the beetle, see Exema. ... Pancreatitus can be caused by an Allergic Reaction to a food. ... Heredity (the adjective is hereditary) is the transfer of characteristics from parent to offspring through their genes, or the transfer of a title, style or social status through the social convention known as inheritance (for example, a Hereditary Title may be passed down according to relevant customs and/or laws). ... An itch (Latin: pruritus) is an uncomfortable sensation felt on an area of skin that causes a person or animal to desire to scratch that area. ...

Causes

Irritant diaper dermatitis develops when skin is exposed to prolonged wetness, increased skin pH caused by urine and feces, and resulting breakdown of the stratum corneum, or outermost layer of the skin. In adults, the stratum corneum is composed of 25 to 30 layers of flattened dead keratinocytes, which are continuously shed and replaced from below. These dead cells are interlaid with lipids secreted by the stratum granulosum just underneath, which help to make this layer of the skin a waterproof barrier. The stratum corneum's function is to reduce water loss, repel water, protect deeper layers of the skin from injury and to repel microbial invasion of the skin (Tortora and Grabowski, 2003). In infants, this layer of the skin is much thinner and more easily disrupted. The correct title of this article is . ... This article or section is in need of attention from an expert on the subject. ... Horse feces Feces, faeces, or fæces (see spelling differences) is a waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... The stratum corneum (the horny layer) is the outermost layer of the epidermis (the outermost layer of the skin). ... The keratinocyte is the major cell type of the epidermis, making up about 90% of epidermal cells. ... Figure 1: Basic lipid structure. ... Stratum granulosum contains 3 to 5 rows of flattened cells whose cytoplasm contains small granules. ... A microorganism or microbe is an organism that is so small that it is microscopic (invisible to the naked eye). ...

Urine's effects

Although wetness alone macerates the skin, softening the stratum corneum and greatly increasing susceptibility to friction injury, urine has an additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only a mild skin irritant, when urea breaks down in the presence of fecal urease it increases skin pH, which in turn promotes the activity of fecal enzymes such as protease and lipase (Atherton, 2004; Wolf, Wolf, Tuzun and Tuzun, 2001). These fecal enzymes increase the skin's permeability to bile salts and act as irritants in and of themselves. The correct title of this article is . ... Ammonia is a compound with the formula NH3. ... Urea is an organic compound with the chemical formula (NH2)2CO. Urea is also known as carbamide, especially in the recommended International Nonproprietary Names (rINN) in use in Europe. ... Helicobacter Pylori Urease drawn from PDB 1E9Z. Urease (EC 3. ... Feces (also spelled faeces in British English, or fæces) are semi-solid waste products from the digestive tract expelled through the anus (or cloaca) during defecation. ... Neuraminidase ribbon diagram An enzyme (in Greek en = in and zyme = blend) is a protein, or protein complex, that catalyzes a chemical reaction and also controls the 3D orientation of the catalyzed substrates. ... Proteases (proteinases, peptidases, or proteolytic enzymes) are enzymes that break peptide bonds between amino acids of proteins. ... A computer-generated image of a type of pancreatic lipase (PLRP2) from the guinea pig. ... Bile is also another name for Belenus, a god in Brythonic mythology. ...

Diet's effects

The interaction between fecal enzyme activity and IDD explains the observation that infant diet and diaper rash are linked, since fecal enzymes are in turn affected by diet. Breast-fed babies, for example, have a lower incidence of diaper rash, possibly because their stools have lower pH and lower enzymatic activity (Hockenberry, 2003). Diaper rash is also most likely to be diagnosed in infants 8–12 months old, perhaps in response to an increase in eating solid foods and dietary changes around that age that affect fecal composition. Any time an infant’s diet undergoes a significant change (i.e. from breast milk to formula or from milk to solids) there appears to be an increased likelihood of diaper rash (Atherton and Mills, 2004).

The link between feces and IDD is also apparent in the observation that infants are more susceptible to developing diaper rash after treatment with antibiotics, which affect the intestinal microflora (Borkowski, 2004; Gupta & Skinner, 2004). Also, there is an increased incidence of diaper rash in infants who have suffered from diarrhea in the previous 48 hours, which may be due to the fact that fecal enzymes such as lipase and protease are more active in feces which have passed rapidly through the gastrointestinal tract (Atherton, 2004). An antibiotic is a drug that kills or slows the growth of bacteria. ... Escherichia coli, one of the many species of bacteria present in the human gut. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... A computer-generated image of a type of pancreatic lipase (PLRP2) from the guinea pig. ... Proteases (proteinases, peptidases, or proteolytic enzymes) are enzymes that break peptide bonds between amino acids of proteins. ... Upper and Lower gastrointestinal tract The gastrointestinal tract (GI tract), also called the digestive tract, or the alimentary canal, is the system of organs within multicellular animals that takes in food, digests it to extract energy and nutrients, and expels the remaining waste. ...

Secondary infections

The significance of secondary infection in IDD remains controversial. Atherton contends that, “Candida albicans can only be isolated from a minority of IDD cases; in many cases this is a reflection of antibiotic therapy. It has also been established that bacterial infection does not play a substantial part in the development of IDD.”(Atherton, 2004, p. 646). A secondary infection is an infection by a microorganism subsequent to and simultaneous with an infection by a different microorganism. ... Binomial name Candida albicans (C.P. Robin) Berkhout 1923 Synonyms Candida stellatoidea [1] Candida albicans is a diploid asexual fungus (a form of yeast), and a causal agent of opportunistic oral and vaginal infections in humans. ...

However, there is little argument that once the stratum corneum has been damaged by a combination of physical and chemical factors, the skin is necessarily more vulnerable to secondary infections by bacteria and fungi. In analyzing swab samples at the perianal, inguinal and oral areas of 76 infants, Ferrazzini et al. (2003) found that colonization with Candida albicans was significantly more likely in children with symptomatic diaper rash than without. Staphylococcus aureus was also present more frequently in symptomatic than in healthy infants, but the difference was not statistically significant. A wide variety of other infections has been reported on occasion, including Proteus mirabilis, enterococci and Pseudomonas aeruginosa, but it appears that Candida is the most common opportunistic invader in diaper areas (Ferrazzini et al., 2003; Ward et al., 2000). Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Divisions Chytridiomycota Zygomycota Ascomycota Basidiomycota The Fungi (singular: fungus) are a large group of organisms ranked as a kingdom within the Domain Eukaryota. ... Binomial name Candida albicans (C.P. Robin) Berkhout 1923 Synonyms Candida stellatoidea [1] Candida albicans is a diploid asexual fungus (a form of yeast), and a causal agent of opportunistic oral and vaginal infections in humans. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Binomial name Proteus mirabilis Hauser 1885 Proteus mirabilis is a Gram-negative, facultatively anaerobic bacterium. ... Species E. faecalis etc. ... Binomial name Pseudomonas aeruginosa (Schroeter 1872) Migula 1900 Synonyms Bacterium aeruginosum Schroeter 1872 Bacterium aeruginosum Cohn 1872 Micrococcus pyocyaneus Zopf 1884 Bacillus aeruginosus (Schroeter 1872) Trevisan 1885 Bacillus pyocyaneus (Zopf 1884) Flügge 1886 Pseudomonas pyocyanea (Zopf 1884) Migula 1895 Bacterium pyocyaneum (Zopf 1884) Lehmann and Neumann 1896 Pseudomonas polycolor... Binomial name Candida albicans (C.P. Robin) Berkhout 1923 Synonyms Candida stellatoidea [1] Candida albicans is a diploid asexual fungus (a form of yeast), and a causal agent of opportunistic oral and vaginal infections in humans. ...

Although apparently healthy infants sometimes culture positive for Candida and other organisms without exhibiting any symptoms, there does seem to be a positive correlation between the severity of the diaper rash noted and the likelihood of secondary involvement (Ferrazzini et al., 2003; Gupta & Skinner, 2004; Wolf et al., 2001). Binomial name Candida albicans (C.P. Robin) Berkhout 1923 Synonyms Candida stellatoidea [1] Candida albicans is a diploid asexual fungus (a form of yeast), and a causal agent of opportunistic oral and vaginal infections in humans. ...

Treatments

The most effective treatment, although not always the most practical one, is to discontinue use of diapers, allowing the affected skin to air out. Other commonly recommended remedies include oil-based protectants, often using various over-the-counter "diaper creams", but sometimes people use petroleum jelly and shark liver oil or cod liver oil; zinc oxide based ointments, and, in extreme cases, anti-fungal cremes. Low concentration hydrocortisone creams are also sometimes used to treat the symptoms of diaper rash, although they do little to clear up the rash itself. Some claim that discontinuing the use of baby "wipes" can be effective in alleviating the symptoms of diaper rash. Petroleum jelly, vaseline, petrolatum or soft paraffin [3] is a semi-solid mixture of hydrocarbons, originally promoted as a topical ointment for its healing properties. ... Shark liver oil is obtained from sharks caught for food purposes only, living in cold, deep oceans. ... Capsules of Cod Liver Oil Cod liver oil, as its name suggests, is an oil extracted from cod livers. ... Zinc oxide is a chemical compound with formula ZnO. It is nearly insoluble in water but soluble in acids or alkalis. ... Hydrocortisone is a synthetic corticosteroid drug which may be given by injection or by topical application. ...

References

• Atherton, D.J. (2001) The aetiology and management of irritant diaper dermatitis. Journal of the European Academy of Dermatology and Venereology 15 (Supplement 1), p. 1-4.

• Atherton, D.J. (2004) A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis. Current Medical Research and Opinion, 20(5), p. 645-649.

• Atherton, D.J. & Mills, K. (2004) What can be done to keep babies’ skin healthy? RCM Midwives Journal, 7(7), p. 288-290.

• Borkowski, S. (2004) Diaper rash care and management. Pediatric Nursing, 30 (6) p. 467-470.

• Concannon P, Gisoldi E, Phillips S, Grossman R. (2001) Diaper dermatitis: a therapeutic dilemma. Results of a double-blind placebo controlled trial of miconazole nitrate 0.25%. Pediatric Dermatology, 18(2) p.149-55.

• Ferrazzini, G., Kaiser, R.R., Hirsig Cheng, S.K., Wehrli, M., Della Casa, V., Pohlig, G., Gonser, S., Graf, F. & Jorg, W. (2003) Microbiological aspects of diaper dermatitis. Dermatology, 206, p. 136-141.

• Gupta, A.K., Skinner, A.R. (2004) Management of diaper dermatitis. International Journal of Dermatology, 43 p. 830-834.

• Hockenberry, M.J. (2003) Wong’s Nursing Care of Infants and Children. St. Louis, MO; Mosby, Inc.

• Tortora, G.J & Grabowski, S.R. (2003) Principles of Anatomy and Physiology, Tenth Edition; New York, NY; John Wiley & Sons, Inc.

• Ward, D.B, Fleischer, A.B., Feldman, S.R., & Krowchuk, D.P. (2000). Characterization of diaper dermatitis in the United States. Archives of Pediatrics & Adolescent Medicine, 154 (9), p. 943-946.

• Wolf, R., Wolf, D., Tuzun, B. & Tuzun, Y. (2001) Diaper Dermatitis. Clinics in Dermatology, 18, p. 657-660.

External links

• Some practical advice for dealing with the condition
• Links to pictures of Diaper Rash (Hardin MD/Univ of Iowa)