Irritant diaper dermatitis

Diaper candidiasis, thrush nappy dermatitis, nappy thrush nappy dermatitis.

Dermatitis triggered by the occlusion effect of nappies.

• Type I: infants (up to 35% of infants develop nappy dermatitis)
• Type II: in elderly persons in need of care

• Cumulative irritative factors caused by nappy use are causative
• Moisture exposure is aggravated by urinary and faecal incontinence, diarrhoea, etc
• The weeping erosions create a good environment for colonisation for Candida albicans. If intestinal candidiasis is present, the risk of secondary mycological infection is increased

• Surfaced, weeping, partly confluent erosions, macerations, partly scaling. Vesicles and pustules may also be seen
• In very rare cases, ulcers (Jaquet's ulcers) may develop
• Satellite lesions are possible

• Bacterial swab in case of suspicion of secondary bacterial colonisation
• Mycology swab in case of suspicion of secondary bacterial colonisation
• In rare cases: Mycology examination of the stool to exclude systemic candidiasis

Diaper area.

Secondary infections (bacterial and mycotic).

• If there is no erosion, lipophilic pastes (pasta zinci) are recommended for skin care
• Alternatively: lipophilic pastes/creams with olive oil

• No nappies (as far as possible, if necessary only by the hour) or frequent changing (avoidance of ↑ moisture)
• If nappies are used, they should contain a gel pad
• Cleaning should only be done with clear water paper towels with olive oil
• Keep the region dry!
• Dry blowing!

• If necessary, apply a thin layer of nystatin-zinc paste several times a day
• NO fluorinated glucocorticoids!

1. Berg RW, Buckingham KW, Stewart RL. Etiologic Factors in Diaper Dermatitis: The Role of Urine. Pediatric Dermatology 1986;3:102-6.
2. Buckingham KW, Berg RW. Etiologic Factors in Diaper Dermatitis: The Role of Feces. Pediatric Dermatology 1986;3:107-12.
3. Smith WJ, Jacob SE. The Role of Allergic Contact Dermatitis in Diaper Dermatitis. Pediatric Dermatology 2009;26:369-70.