Citizendia

Diaper rash
Classification and external resources
ICD-10L22.
ICD-9691.0

Diaper rash (U.S.) or nappy rash (UK), is a generic term applied to skin rashes in the diaper area that are caused by 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 The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings L00-L99 - Diseases of the Skin and Subcutaneous tissue (L00-L08 Infections of the Skin and Subcutaneous tissue The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the The skin is the outer covering of living tissue of an animal (or plant "Nappy" redirects here For other uses see Nappy (disambiguation and Diaper (disambiguation.

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 redness of the Skin caused by Capillary congestion Skin folds are areas of Skin where it folds Many skin folds are distinct heritable anatomical features and may be used for identification of animal Species, while

Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i. Dermatitis is a Blanket term meaning any " Inflammation of the skin" (e The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border (Hockenberry, 2003). Erythema is redness of the Skin caused by Capillary congestion An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process

Contents

Differential diagnosis

Other rashes that occur in the diaper area include Seborrheic dermatitis and Atopic dermatitis. Seborrhoeic Eczema (also Seborrheic dermatitis AmE, seborrhea) is a skin disorder affecting the scalp face and trunk causing scaly flaky Atopic dermatitis, also known as atopic eczema, is a disease characterized by Chronic inflammation of the skin which is atopic, hereditary and non-contagious Both Seborrheic and Atopic dermatitis require individualized treatment; they are not the subject of this article.

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. pH is the measure of the acidity or alkalinity of a Solution. Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus The stratum corneum ("horny layer" is the outermost layer of the epidermis (the 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. The keratinocyte is the major cell type of the epidermis, making up about 90% of epidermal cells 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. Lipids are broadly defined as any fat- Soluble ( lipophilic) naturally-occurring Molecule, such as fats oils waxes cholesterol sterols fat-soluble In Microscopic views of Skin, the stratum granulosum layer of the epidermis lies between the Stratum spinosum, below and the Stratum lucidum 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). A microorganism (also spelled micro organism or micro-organism and also called a microbe) is an Organism that is Microscopic (usually In infants, this layer of the skin is much thinner and more easily disrupted.

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. pH is the measure of the acidity or alkalinity of a Solution. 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). Ammonia is a compound with the formula N[[hydrogen H3]] It is normally encountered as a Gas with a characteristic pungent Odor Urea is an Organic compound with the Chemical formula ( N[[hydrogen H]]22 C[[oxygen O]] Urease ( is an Enzyme that catalyzes the Hydrolysis of Urea into Carbon dioxide and Ammonia. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins A protease is any Enzyme that conducts Proteolysis, that is begins protein Catabolism by Hydrolysis of the Peptide bonds that link A lipase is a Water-soluble Enzyme that Catalyzes the Hydrolysis of Ester bonds in water–insoluble Lipid These fecal enzymes increase the skin's permeability to bile salts and act as irritants in and of themselves. Bile acids (also known as bile salts are Steroid Acids found predominantly in the Bile of Mammals.

Disposable diapers draw urine away from skin, unlike cloth diapers, and therefore are far less likely to cause diaper rash. [1]

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). In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa The gut flora are the Microorganisms that normally live in the Digestive tract and can perform a number of useful functions for their hosts 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). In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea A lipase is a Water-soluble Enzyme that Catalyzes the Hydrolysis of Ester bonds in water–insoluble Lipid A protease is any Enzyme that conducts Proteolysis, that is begins protein Catabolism by Hydrolysis of the Peptide bonds that link

Secondary infections

The significance of secondary infection in IDD remains controversial. An infection is the detrimental Colonization of a host Organism by a foreign Species. 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. Candida albicans is a Diploid Fungus (a form of Yeast) which is capable of mating but not of Meiosis, and a causal agent of It has also been established that bacterial infection does not play a substantial part in the development of IDD. ”(Atherton, 2004, p. 646).

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. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have A fungus (ˈfʌŋgəs is a eukaryotic Organism that is a member of the kingdom Fungi (ˈfʌndʒaɪ 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. Candida albicans is a Diploid Fungus (a form of Yeast) which is capable of mating but not of Meiosis, and a causal agent of Staphylococcus aureus was also present more frequently in symptomatic than in healthy infants, but the difference was not statistically significant. Staphylococcus aureus (ˌstæfɨləˈkɒkəs ˈɔriəs literally "Golden Cluster Seed" and also known as golden staph) is the most common cause of 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. Proteus mirabilis is a Gram-negative, facultatively anaerobic Bacterium. Enterococcus is a Genus of Lactic acid bacteria of the phylum Firmicutes. Pseudomonas aeruginosa is a Gram-negative, aerobic, rod-shaped Bacterium with unipolar motility. Candida albicans is a Diploid Fungus (a form of Yeast) which is capable of mating but not of Meiosis, and a causal agent of , 2003; Ward et al. , 2000).

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. Candida albicans is a Diploid Fungus (a form of Yeast) which is capable of mating but not of Meiosis, and a causal agent of , 2003; Gupta & Skinner, 2004; Wolf et al. , 2001).

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. Petroleum jelly, petrolatum or soft paraffin is a Semi-solid mixture of Hydrocarbons (with Carbon numbers mainly higher than 25 Shark liver oil is obtained from Sharks that are caught for food purposes and are living in cold deep Oceans The liver oil from sharks has been used by fishermen for This article is about the fish extract for the traditional Newfoundland song see " Cod Liver Oil (song " Zinc oxide is a Chemical compound with the formula ZnO It is nearly insoluble in water but soluble in Acids and Bases It occurs 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. Cortisol is a Corticosteroid Hormone produced by the Adrenal gland (in the Zona fasciculata of the Adrenal cortex)

Keeping the baby's skin clean is considered another important factor in treatment.

Some sources claim that diaper rash is more common with cloth diapers,[1] yet others claim that the type of diaper makes no difference, but that cloth diapers can speed the healing process. [2]

Some claim that discontinuing the use of baby "wipes" can be effective in alleviating the symptoms of diaper rash.

References

  1. ^ Patient information: Diaper rash in infants and children. UpToDate Marketing.
  2. ^ Diapers/Diaper Rash. UVa Health System.

External links

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