Irritable diaper dermatitis is a generic term used in skin rashes in the diaper area caused by various skin disorders and/or irritants.
Generic diaper rash or irritable diaper dermatitis (IDD) is characterized by entangled spots of erythema and scaling mainly seen on the convex surface, with avoidable skin folds.
Diaper dermatitis with bacterial or secondary fungal involvement tends to spread to the concave surface (ie, skin folds), as well as convex surfaces, and often indicates central red erythema, grease with satellite pustules around the border.
Usually considered as a form of irritant contact dermatitis. The word "diaper" in the name not because the diaper itself causes a rash but rather because the rash is associated with the use of the diaper, caused by the material trapped by the diaper (usually the dirt). Allergic contact dermatitis has also been suggested, but there is little evidence for this cause. In adults with incontinence (fecal, urine, or both), the rash is sometimes called dermatitis-related incontinence (IAD).
The term candidiasis of the diaper is used when the origin of the fungus is identified. The difference is very important because the treatment (antifungal) is completely different.
Video Irritant diaper dermatitis
Cause
Irritable diaper dermatitis develops when the skin is exposed to prolonged wet, increased pH of the skin caused by a combination, and subsequent reactions, urine and impurities, and damage resulting from the stratum corneum, or the outermost layer of the skin. This may be due to diarrhea, frequent stools, tight diapers, too much exposure to ammonia, or allergic reactions. In adults, the stratum corneum consists of 25 to 30 layers of flattened die keratinocytes, which are continuously dumped and replaced from below. These dead cells are interspersed with lipids secreted by the stratum granulosum just below them, which helps make this skin layer a waterproof barrier. The function of the stratum corneum is to reduce water loss, expel water, protect the deeper layers of the skin from injury, and to expel the microbial invasion of the skin. In infants, this skin layer is thinner and more easily distracted.
Urine
Although wet alone has a macerated skin effect, softens the stratum corneum, and greatly increases susceptibility to frictional injury, urine has an additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only mild skin irritation, when urea is damaged in the presence of feces urease it increases the pH because ammonia is released, which in turn promotes the activity of fecal enzymes such as proteases and lipases. This fecal enzyme improves skin hydration and permeability to bile salts that also act as skin irritants.
There is no detectable difference in the rate of diaper rash in conventional disposable diaper users and reusable cloth diapers. "Infants using disposable superabsorbent diapers with middle gel materials have fewer episodes of diaper dermatitis than their cloth-wearing counterparts, but keep in mind that superabsorbent diapers contain dyes that allegedly cause allergic contact dermatitis (ACD). " Whether to wear cloth or disposable diapers they should be frequently replaced to prevent diaper rash, even if they do not feel wet. To reduce the onset of diaper rash, disposable diapers have been engineered to draw moisture from baby's skin using synthetic gel that can not decompose. Today, cloth diapers use the new superabsorbent microfiber fabric available that is placed in a pocket with a layer of light permeable material that touches the skin. This design serves to draw moisture from the skin to the microfiber cloth. This technology is used in most of today's cloth pocket cloth brands.
Diet
The interaction between fecal enzyme activity and IDD explains the observation that baby diets and diaper rash are linked because faecal enzymes are in turn influenced by diet. Breast-fed babies, for example, have a lower incidence of diaper rash, probably because their stools have higher pH and lower enzymatic activity. Diaper rash is also most likely diagnosed in infants aged 8-12 months, possibly in response to increased eating of solid foods and dietary changes around the age that affect the composition of the feces. Whenever a baby's diet changes significantly (ie from breast milk to formula or from milk to solid foods) there appears to be an increased chance of diaper rash.
The relationship between impurities and IDD is also clear in the observation that babies are more susceptible to developing diaper rash after being treated with antibiotics, which affect intestinal microflora. Also, there is an increased incidence of diaper rash in infants who have had diarrhea within the previous 48 hours, which may be due to faecal enzymes such as lipases and proteases being more active in the rapidly passing stool through the gastrointestinal tract.
Secondary infection
The significance of secondary infections in IDD is still controversial. There appears to be no relationship between the presence or absence of IDD and the amount of microbes. Although it appears that healthy babies are sometimes a positive culture for Candida and other organisms without any symptoms, there appears to be a positive correlation between the severity of the diaper rash being noted and the likelihood of secondary involvement. Various infections have been reported, including Staphylococcus aureus, Streptococcus pyogenes, Proteus mirabilis, enterococci and Pseudomonas aeruginosa, but apparently Candida i> is the most common opportunistic invader in the diaper area.
Maps Irritant diaper dermatitis
Diagnosis
The diagnosis of IDD is made clinically, by observing the limitations of erythematous eruptions to the convex surface of the genital area and the buttocks. If diaper dermatitis occurs for more than 3 days it may be colonized with Candida albicans, giving it redness, sharp marginalization, the appearance of diaper candidiasis.
Differential diagnosis
Other rashes that occur in the diaper area include seborrhoeic dermatitis and atopic dermatitis. Both seborrhoeic and atopic dermatitis require individual care; they are not the subject of this article.
- Seborrhoeic dermatitis, characterized by oily scales, yellowish thickness, most commonly seen on the scalp (cradle cap) but can also appear in inguinal folds.
- Atopic dermatitis, or eczema, is associated with an allergic reaction, often hereditary. This class of rash can appear anywhere in the body and is characterized by a strong itching.
Treatment
Possible treatments include minimizing the use of diapers, barrier creams, mild topical cortisone, and antifungal agents. Various inflammatory and other infectious processes may occur in the diaper area and awareness of this type of secondary diaper dermatitis in an accurate diagnosis and treatment of patients.
Diaper changed
The most effective treatment, though not the most practical, is to stop using diapers, which allows exposed skin to come out of the air. Another option is to increase the frequency of diaper replacement. Drying the skin thoroughly before changing the diaper is a good precaution because it is the excess moisture, either from urine and dirt or due to sweating, which causes diaper rash conditions to occur.
Nappy type
Some sources claim that diaper rash is more common with cloth diapers. Others claim that the diaper material is relevant as far as it can absorb moisture from the baby's skin, and prevent secondary infection of Candida . However, there may not be enough data from a good quality randomized controlled trial to support or reject the use of disposable diapers so far. In addition, the effects of diapers that can not be decomposed on the environment are issues related to public policy.
Cream, ointment
Another approach is to block moisture from reaching the skin, and the drugs that are usually recommended using this approach include oil-based or barrier creams, over-the-counter "petroleum creams", petroleum jelly, dimethicone and other oils. Such sealants sometimes reach the opposite if the skin is not completely dry, in which case they serve to seal the moisture inside the skin rather than outside.
Zinc oxide based ointments such as Pinxav can be very effective, especially in prevention, as they have a drying and astringent effect on the skin, which is slightly antiseptic without causing irritation.
Danger using powder
Various powders that absorb moisture, such as talcum or starch, reduce moisture but can introduce other complications. Any water powder can irritate the lung tissue, and powder made from plant flour (corn, arrowroot) provides food for mushrooms and is not recommended by the American Academy of Dermatology.
Antifungi
In a severe or persistent rash, an antifungal cream should often be used. In cases where the rash is more of an irritation, a mild topical corticosteroid preparation , eg. hydrocortisone cream, is used. Because it is often difficult to distinguish yeast infections from skin irritation, many doctors prefer the combination of corticosteroid and antifungal creams such as hydrocortisone/miconazole.
See also
References
External links
- Diaper Rash Picture (Hardin MD/Univ of Iowa)
Source of the article : Wikipedia
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