Emergency Strategy - How to treat diaper rash

Emergency Strategy - How to treat diaper rash
Diaper rash mostly develop in infant during the first month of life or during the 12- 24 months of life. Diaper rash usually doesn’t require any admission to the hospital unless the child develop symptoms and signs of sepsis or present with evidence of child abuse or child neglect. Diaper rash may also effect elderly who is incontinent.
As a general rule, if the child suffer from diaper rash, firstly make sure that the child airway is open , the child breathing is normal, the child has pulse and not dehydrated. The airway, breathing and circulatory assessment are important in any emergency /acute conditions.
The next step include treatment with barrier cream. Barrier cream is applied after each diaper changes. As a safety measure against recurrence, barrier cream is applied even after the rash has resolved. The preparation of barrier cream include lanolin, petroleum and zinc oxide.
Antifungal is considered in case of candida infection. Antifungal such as miconazole and clotrimazole as well as ciclopirox are applied after diaper changes topically. Antifungal medication available in the form of oral, cream, ointment or powder. Oral antifungal is considered in case of oral candidiasis, concurrent cutaneous infection or recalcitrant cases as the big stool being colonized with Candida albicans . Maceration is avoided by sparingly applied the cream. If the skin is macerated consider giving ointment. Any intertriginous areas are best treated with lotion. Antifungal also has an antibacterial properties and useful in treating inflammatory condition ( anti inflammatory agent). Antifungal is continue for 2 days and expect improvement by 2 days.
Antibacterial agent is rarely considered in treating diaper rash. It is only considered if the infant suffer from recurrent attack of diaper rash and mupirocin is applied. Systemic antibiotic agent is rarely given.
Corticosteroids such as cream of hydrocortisone is considered in cases ( moderate or severe) if other treatment is failed.
Other form of treatment include frequent change of diaper from 1 hour to every 4 hours . Avoiding cloth diapers. Consider highly absorbable diapers. Warm water and saline are used to gently rinse the affected area. Remember to use water and cotton balls to frequently clean the skin. Alcohol wipes, talcum powder and wet wipe are not recommended. Area should be uncover and allow to dry by itself.
The child may present with erythematous base lesion on different part of the body such as the scalp. Erythematous base lesion may present with gray scale or greasy yellow scale. This condition is known as seborrheic diaper dermatitis.
Infection form of diaper rash is characterized by bullae, yellow crust with superficial erosion or the present of satellite lesions of pustules , papule and demarcated erythematous lesion affecting the fold of the skin. This is mostly associated with infection form of diaper rash.
Irritant or atopic diaper dermatitis may present with beefy red confluent patches at the edge of diaper with borders and not affecting the fold of the skin.
In certain cases such as psoriasis, there will be psoriatic form /erythematous plaque of silvery scales on the skin surface. Diarrhea may also associated with diaper rash such as variant of Jacquet form erosive lesion with ulcers and elevated margins.
Violaceous nodules and papules on the buttocks or groin are known as granuloma gluteale infantum which resolve with residual scaring after a few weeks.
Diaper rash may also be mistaken for other disorders such as psoriasis, varicella zoster, epidermolysis bullosa, seborrheic dermatitis, herpes simplex, Langerhans cell histiocytosis, bullous pemphigoid, acrodermatitis enteropathica, atopic dermatitis, congenital syphilis, papular urticaria, scabies, impetigo and evidence of child neglect or abuse.
Candida infection or seborrheic dermatitis are differentiated based on skin scraping with potassium hydroxide and culture.
Diaper rash is divided into contact dermatitis or due to fungal or bacterial infection. Contact dermatitis/irritant dermatitis may be caused by chemical such as from material or adhesive to hold the diaper, the material of the diaper itself, the moisturizer or scent or due to urine or stool prolonged exposure. Friction from skin and diaper ( rubbing ) or moisture due to infrequent change of diaper, cloth diaper and poorly absorbent properties of diaper may lead to irritant/contact dermatitis. Irritant such as friction may lead to the broken down of the outer layer of the skin which lead to a loss in a protective barrier and causing inflammation reaction. Moist environment may encourage the growth of microorganism.
Bacterial infection may include E. coli, staphylococcus aureus and bacteroides are common while Candida albicans are most common fungal related diaper rash. Candida albicans may growth due to the use of systemic antibiotics and associated with oral thrush.
References
1.Davis, James A., James J. Leyden, Gary L. Grove, and William J. Raynor. “Comparison of Disposable Diapers with Fluff Absorbent and Fluff Plus Absorbent Polymers: Effects on Skin Hydration, Skin pH, and Diaper Dermatitis.” Pediatric Dermatology 6, no. 2 (1989): 102–108. doi:10.1111/j.1525-1470.1989.tb01005.
2.Buckingham, Kent W. “Methods for the Treatment and Prophylaxis of Diaper Rash and Diaper Dermatitis,” December 3, 1985.
3.Rw, Berg. “Etiology and Pathophysiology of Diaper Dermatitis.” Advances in Dermatology 3 (December 1987): 75–98.
4.Borkowski, Suzanne. “Diaper Rash Care and Management.” Pediatric Nursing 30, no. 6 (December 2004): 467–470.
Diaper rash mostly develop in infant during the first month of life or during the 12- 24 months of life. Diaper rash usually doesn’t require any admission to the hospital unless the child develop symptoms and signs of sepsis or present with evidence of child abuse or child neglect. Diaper rash may also effect elderly who is incontinent.
As a general rule, if the child suffer from diaper rash, firstly make sure that the child airway is open , the child breathing is normal, the child has pulse and not dehydrated. The airway, breathing and circulatory assessment are important in any emergency /acute conditions.
The next step include treatment with barrier cream. Barrier cream is applied after each diaper changes. As a safety measure against recurrence, barrier cream is applied even after the rash has resolved. The preparation of barrier cream include lanolin, petroleum and zinc oxide.
Antifungal is considered in case of candida infection. Antifungal such as miconazole and clotrimazole as well as ciclopirox are applied after diaper changes topically. Antifungal medication available in the form of oral, cream, ointment or powder. Oral antifungal is considered in case of oral candidiasis, concurrent cutaneous infection or recalcitrant cases as the big stool being colonized with Candida albicans . Maceration is avoided by sparingly applied the cream. If the skin is macerated consider giving ointment. Any intertriginous areas are best treated with lotion. Antifungal also has an antibacterial properties and useful in treating inflammatory condition ( anti inflammatory agent). Antifungal is continue for 2 days and expect improvement by 2 days.
Antibacterial agent is rarely considered in treating diaper rash. It is only considered if the infant suffer from recurrent attack of diaper rash and mupirocin is applied. Systemic antibiotic agent is rarely given.
Corticosteroids such as cream of hydrocortisone is considered in cases ( moderate or severe) if other treatment is failed.
Other form of treatment include frequent change of diaper from 1 hour to every 4 hours . Avoiding cloth diapers. Consider highly absorbable diapers. Warm water and saline are used to gently rinse the affected area. Remember to use water and cotton balls to frequently clean the skin. Alcohol wipes, talcum powder and wet wipe are not recommended. Area should be uncover and allow to dry by itself.
The child may present with erythematous base lesion on different part of the body such as the scalp. Erythematous base lesion may present with gray scale or greasy yellow scale. This condition is known as seborrheic diaper dermatitis.
Infection form of diaper rash is characterized by bullae, yellow crust with superficial erosion or the present of satellite lesions of pustules , papule and demarcated erythematous lesion affecting the fold of the skin. This is mostly associated with infection form of diaper rash.
Irritant or atopic diaper dermatitis may present with beefy red confluent patches at the edge of diaper with borders and not affecting the fold of the skin.
In certain cases such as psoriasis, there will be psoriatic form /erythematous plaque of silvery scales on the skin surface. Diarrhea may also associated with diaper rash such as variant of Jacquet form erosive lesion with ulcers and elevated margins.
Violaceous nodules and papules on the buttocks or groin are known as granuloma gluteale infantum which resolve with residual scaring after a few weeks.
Diaper rash may also be mistaken for other disorders such as psoriasis, varicella zoster, epidermolysis bullosa, seborrheic dermatitis, herpes simplex, Langerhans cell histiocytosis, bullous pemphigoid, acrodermatitis enteropathica, atopic dermatitis, congenital syphilis, papular urticaria, scabies, impetigo and evidence of child neglect or abuse.
Candida infection or seborrheic dermatitis are differentiated based on skin scraping with potassium hydroxide and culture.
Diaper rash is divided into contact dermatitis or due to fungal or bacterial infection. Contact dermatitis/irritant dermatitis may be caused by chemical such as from material or adhesive to hold the diaper, the material of the diaper itself, the moisturizer or scent or due to urine or stool prolonged exposure. Friction from skin and diaper ( rubbing ) or moisture due to infrequent change of diaper, cloth diaper and poorly absorbent properties of diaper may lead to irritant/contact dermatitis. Irritant such as friction may lead to the broken down of the outer layer of the skin which lead to a loss in a protective barrier and causing inflammation reaction. Moist environment may encourage the growth of microorganism.
Bacterial infection may include E. coli, staphylococcus aureus and bacteroides are common while Candida albicans are most common fungal related diaper rash. Candida albicans may growth due to the use of systemic antibiotics and associated with oral thrush.
References
1.Davis, James A., James J. Leyden, Gary L. Grove, and William J. Raynor. “Comparison of Disposable Diapers with Fluff Absorbent and Fluff Plus Absorbent Polymers: Effects on Skin Hydration, Skin pH, and Diaper Dermatitis.” Pediatric Dermatology 6, no. 2 (1989): 102–108. doi:10.1111/j.1525-1470.1989.tb01005.
2.Buckingham, Kent W. “Methods for the Treatment and Prophylaxis of Diaper Rash and Diaper Dermatitis,” December 3, 1985.
3.Rw, Berg. “Etiology and Pathophysiology of Diaper Dermatitis.” Advances in Dermatology 3 (December 1987): 75–98.
4.Borkowski, Suzanne. “Diaper Rash Care and Management.” Pediatric Nursing 30, no. 6 (December 2004): 467–470.