The Diaper Rash! The napkin Rash! Irritant Diaper Dermatitis! I’m pretty sure you have heard all these various terms that describe one disease, very common among infants wearing diapers. A quick google search will show tons of information about this common disease. But the problem is available information is incomplete and confusing! Today on Tiny Medicine, We’ll learn all the essential concepts about The Diaper Dermatitis!
- The first mode of skin injury is due to the Friction. Prolonged wetness softens the stratum corneum; the outer most layer of the skin. When this softened skin is rubbed by the wet diaper, the resulting friction can cause injury to the skin.
- The second mode is due to irritation.
- The Average Ph. value of our skin is 5.5; somewhat acidic! The average PH Value of Urine is 6! Slightly basic or alkaline when compared with the skin.
- Things get worse when the baby’s urine is mixed with feces. Feces contain and an enzyme called Urease. This enzyme breaks down Urea into ammonia. Now ammonia is a weak base. This will further increase the Ph value of the skin.
- This high ph. will activate fecal enzymes like proteases and lipases, which will in-turn breakdown proteins and lipids of the skin.
- The skin is made of cells called keratinocytes. In some ways, they are just like babies. When babies pass urine or feces, they cry and create chaos! Likewise, when the skin is “irritated” by urine and feces, these keratinocytes release “cytokines” and create chaos.
- Cytokines attract white blood cells and activate an immune reaction. This will further damage the skin and give rise to the symptoms of the diaper rash.
- There’s a third mode of injury as well. It is due to the secondary infection of the existing diaper rash by candida or bacteria.
So what are the symptoms?
- The rash will be erythematous – which means red. The skin may have a scalded appearance as well. In severe cases, there can be skin erosion and ulcers too.
- One key feature is that flexure creases of the skin will be spared- because these creases are not in direct contact with the contaminated diaper.
- If the flexure creases are also involved, then we’ll have to look for other causes like candida infections and seborrheic dermatitis.
The treatment is often simple.
- Using Emollients like Zinc Oxide paste or petrolatum will help to maintain the skin dryness.
- Super-absorbent Diapers will reduce the diaper rash by absorbing most of the urine and feces.
- Severe cases may need topical steroid application.
- And if the diaper rash is complicated with a candida infection, the doctors will prescribe topical antifungals as well.