Compound oleum lithospermi in improving clinical symptoms of mild to moderate diaper dermatitis: a multicenter, open-labeled, randomized controlled clinical study / 中华皮肤科杂志

Objective:To evaluate clinical efficacy and safety of topical compound oleum lithospermi in the treatment of mild to moderate diaper dermatitis.Methods:A multicenter, randomized, positive-drug parallel-controlled clinical trial was conducted in 19 hospitals from July 2019 to August 2020. Children aged 0 - 12 months with mild to moderate diaper dermatitis were enrolled and randomly divided into 2 groups using a random number table: test group topically treated with compound oleum lithospermi, and control group topically treated with zinc oxide cream. The treatment was carried out 6 - 8 times a day for 7 days. Visits were scheduled on days 0 and 7, and total response rate and clinical healing time were evaluated. Changes in the dermatitis family impact (DFI) score were compared between the test group and control group, and adverse events were recorded. Statistical analysis was carried out by using independent-sample t test for normally distributed continuous data, Wilcoxon rank sum test for non-normally distributed continuous data, and chi-square test or Fisher′s exact test for unordered categorical data; survival curves were drawn, and log-rank test was used for comparisons between two groups. Results:A total of 343 children with diaper dermatitis were enrolled in this study. Among them, 31 children violated the protocol, so 312 were included in the per protocol set, including 157 in the test group and 155 in the control group, and all completed the visits on days 0 and 7. The total response rate was significantly higher in the test group (87.26%, 137/157) than in the control group (78.71%, 122/155; χ2 = 4.04, P = 0.044) . The clinical healing time was significantly shorter in the test group (5.33 days) than in the control group (6.13 days; χ2 = 4.67, P = 0.025) . After 7-day treatment, the DFI score significantly decreased in both the 2 groups compared with that before the treatment, but there was no significant difference in the DFI score between the 2 groups (test group: 4.02 ± 6.96, control group: 3.58 ± 5.90, Z = -0.39, P = 0.686) . The incidence of adverse events was 2.92% (5/171) and 5.45% (9/165) in the test group and control group respectively, and there was no significant difference between the 2 groups ( χ2 = 0.03, P = 0.865) . Conclusion:Compound oleum lithospermi can markedly reduce the clinical severity of diaper dermatitis, improve the total response rate, shorten the clinical treatment period, and improve the quality of life of children′s families with a favorable safety profile.

Síndrome de Cushing secundario a administración tópica decorticoesteroides / Cushing Syndrome due to topical corticosteroid misuse

Los corticoesteroides tópicos son drogas muy comunes, frecuentemente utilizadas en patologías dermatológicas. Su mal uso puede causar efectos sistémicos, como el síndrome de Cushing y la supresión del eje hipotalámico ­ hipofisiario ­ adrenal. Presentamos un caso de un lactante menor de siete meses quien desarrolla un síndrome de Cushing secundario al uso de Clobetasol por una dermatitis en el área del pañal, por tiempo prolongado, sin prescripción médica. Al examen físico se evidencia obesidad a predominio central, con fascie de luna llena, hipertricosis en región frontal, telangiectasias aisladas en mejillas y cuello de búfalo. Los paraclínicos demuestran una hipercolesterolemia, hipertrigliceridemia, elevación de las transaminasas y cortisol sérico en la mañana disminuido. Se concluye que se debe informar a los padres de los efectos adversos sistémicos de los esteroides tópicos y se sugiere evitar en pacientes pediátrico(AU)

Topical corticosteroids are very common drugs used in the treatment of inflammatory skin diseases. Prolonged ormisuse of them may cause systemic adverse effects, including Cushing syndrome and hypothalamic-pituitary-adrenal axissuppression. We present a case of a seven months old maleinfant who developed iatrogenic Cushing syndrome after diaperdermatitis treatment through misuse of Clobetasol, withoutdoctor's prescription. We observe redness and a moon face, abuffalo hump, central obesity and hirsutism. Laboratory values revealed hypercholesterolemia, hypertriglyceridemia, elevationin liver enzymes and low early morning cortisol. To conclude,parents must be informed by physicians about the adverse effect of steroids and the should be avoided in very young infant(AU)

Escala de avaliação do uso de fraldas e absorventes: estudo metodológico / Evaluation scale for the use of adult diapers and absorbent products': methodological study / Escala de evaluación del uso de pañales y absorbentes: estudio metodológico

OBJETIVO: Validar o conteúdo da escala de avaliação do uso de fraldas e produtos absorventes (Escala AUFA) por idosos na atenção primária. MÉTODO: Estudo metodológico de validação de conteúdo com 23 especialistas em enfermagem gerontológica ou feridas pela avaliação do nome e itens da escala. A análise dos dados ocorreu por meio de índice de validação de conteúdo (IVC) e coeficiente de validação de conteúdo (CVC), percentual de concordo totalmente e concordância pelo Alfa de Cronbach, com o mínimo de 0,80 cada. RESULTADOS: Os IVC e CVC gerais foram de, respectivamente, 0,91 e 0,89. Entretanto, os percentuais de concordo completamente e Alfa de Cronbach foram de, respectivamente, 0,65 e 0,51. Após três envios e modificações da escala, a avaliação foi de 0,95 e 0,85. DISCUSSÃO: Os juízes contribuíram para o conteúdo da escala, principalmente quanto ao número de trocas CONCLUSÃO: Após as análises e sugestões dos juízes, o conteúdo foi refinado e validado.

OBJECTIVE: To validate the content of the 'Evaluation Scale for the Use of Adult Diapers and Absorbent Products' (AUFA Scale) among elderly patients in primary care. METHOD: Methodological study for validation of contente with 23 specialists in gerontological nursing and/or wounds for evaluating the name and the items of the scale. The analysis of the data was done according to the Index of Validation of Content (IVC) and the Coefficient of Validation of Content (CVC), the 'Fully Agree" percentage and the compliance to 'Cronbach's Alpha', with a minimum score of 0,80 for each. RESULTS: The general IVC and CVC were 0,91 and 0,89, respectively. However, the 'Fully Agree' and 'Cronbach's Alpha' percentages were 0,65 and 0,51, respectively. After three 3 submissions and modifications of the scale, the scores changed to 0,95 and 0,85. DISCUSSION: Judges contributed to the content of the scale, especially regarding the number of absorbent product changes CONCLUSION: After taking into account the analyses and suggetions made by the judges, the content was refined and considered validated.

OBJETIVO: Validar el contenido de la escala de evaluación para el uso de pañales y productos absorbentes (Escala AUFA) en ancianos en atención primaria. MÉTODO: Estudio metodológico de validación de contenido con 23 especialistas en enfermería gerontológica y/o heridas para la evaluación del nombre y de los ítems de la escala. El análisis de los datos se realizó mediante el Índice de Validación de Contenido (IVC) y el Coeficiente de Validación de Contenido (CVC), así como del porcentaje de la respuesta 'Totalmente de acuerdo' y del 'Alfa de Cronbach', con un puntaje mínimo de 0.80 para cada uno.RESULTADOS: Los IVC y CVC generales fueron de 0.91 y 0.89, respectivamente. Sin embargo, el porcentaje de 'Totalmente de acuerdo' y del 'Alfa de Cronbach' fue de 0.65 y 0.51, respectivamente. Después de 3 presentaciones y modificaciones de la escala, la evaluación fue de 0.95 y 0.85. DISCUSIÓN: Los jueces contribuyeron al contenido de la escala, principalmente en cuanto al número de cambios. CONCLUSIÓN: Luego del análisis y de las sugerencias de los jueces, el contenido se refino el contenido hasta considerarlo validado.

Prevalência de dermatite associada à incontinência em pacientes adultos de um hospital universitário / Prevalence of dermatitis associated with incontinence in adult patients in a university hospital

Introduction: incontinence-associated dermatitis (IAD) is an inflammation of the skin, related to contact with moisture, frequent in patients with urinary and/or anal incontinence, which is an important challenge in nursing care. Objective: to identify the punctual prevalence and characteristics of incontinence-associated dermatitis (IAD) in adult patients admitted to the medical clinic of a general hospital. Method: a descriptive, cross-sectional study, carried out with a non-probabilistic sample of incontinent patients. Data were collected on 2 days in March 2019, through interviews, physical examination and medical records, and analyzed using simple descriptive statistics. Results: a prevalence of dermatitis associated with incontinence of 56.2% was found in incontinent patients. Among the types of incontinence, it was identified that 12.5% of the patients had urinary incontinence, 18.8% anal incontinence and 68.7% double incontinence. IAD was more frequent in women, over 70 years of age, with double incontinence. Conclusion: the prevalence of IAD in the medical clinic of the hospital under study is considered high, with category 2 being more frequent, that is, with skin rupture associated with edema and erythema. The findings raise the need for further studies, discussions and implementation of continuing education in health, especially for nursing care related to the topic.

Introdução: a dermatite associada à incontinência (DAI) é uma inflamação da pele, relacionada ao contato com a umidade, frequente em pacientes com incontinência urinária e/ ou anal que constitui importante desafio no cuidado de enfermagem.Objetivo:identificar a prevalência pontual e as características da dermatite associada à incontinência (DAI) em pacientes adultos internados na clínica médica de um hospital geral. Método:estudo descritivo, de corte transversal,realizado com amostra não probabilística de pacientes incontinentes. Os dados foram coletados em 2 dias do mês de março de 2019, mediante entrevista, exame físico e consulta a prontuário,e analisados por meio de estatística descritiva simples. Resultados:constatou-se prevalência de dermatite associada à incontinência de 56,2% nos pacientes incontinentes.Entre os tipos de incontinência, identificou-se que 12,5%dos pacientes apresentavam incontinência urinária, 18,8% incontinência anal e 68,7% dupla incontinência. A DAI foi mais frequente em mulheres, acima de 70 anos de idade, com dupla incontinência. Conclusão: a prevalência de DAI na clínica médica do hospital em estudo é considerada elevada, sendo mais frequente a categoria 2, ou seja, com ruptura da pele associada a edema e eritema. Os achados suscitam a necessidade de maiores estudos, discussões e implementação de ações de educação permanente em saúde, sobretudo para o cuidado de enfermagem relacionado ao tema.

Dermatite associada à incontinência em idosos hospitalizados: conhecimento autorreferido de enfermeiros / Incontinence-associated dermatitis in hospitalized elderly patients: nurses' self-reported knowledge la dermatitis asociados con / La incontinencia en ancianos hospitalizados: percepción subjetiva de conocimiento del enfermero

Objetivo: Identificar los conocimientos de auto-reporte de las enfermeras en cuanto a la prevención, el diagnóstico y el tratamiento de la dermatitis asociada a la incontinencia (DAI) en ancianos hospitalizados y proponer la construcción de un protocolo de cuidados de enfermería de diagrama de flujo. Métodos: Este exploratorio, descriptivo cualitativo, a través de entrevistas semiestructuradas con enfermeros de unidades de un hospital en la segunda mitad de 2016. Los datos de las entrevistas fueron analizados mediante el análisis temático. Resultados: presentado en tres categorías: Admisión de la Tercera Edad y prevenir la DAI: La mayoría de la clientela es de edad avanzada, en la que la adopción de la higiene y la aplicación de barrera consiste en la prevención; El diagnóstico de la DAI en los ancianos: Sin darse cuenta de la puesta en escena de la DAI; El tratamiento de la DAI: Incluye dispositivos que eviten el contacto con la piel eliminaciones dificultades para diferenciar las categorías de lesiones existentes. Conclusión: La falta de uniformidad entre las enfermeras sobre los productos que tratan la piel con DAI

Objetivo: Identificar o conhecimento autorreferido dos enfermeiros em relação a prevenção, diagnóstico e tratamento da dermatite associada a incontinência (DAI) em idosos hospitalizados e propor a construção de um protocolo de cuidados de enfermagem a partir de fluxograma. Métodos: Pesquisa exploratória descritiva, qualitativa, através de entrevista semiestruturada com enfermeiros de unidades de um hospital, no segundo semestre de 2016. Os dados das entrevistas foram analisados mediante análise temática. Resultados: Apresentados em três categorias: Admissão do idoso e prevenção da DAI: A maioria da clientela é idosa, na qual a adoção de medidas de higiene e aplicação de barreira consistem na prevenção; Diagnóstico da DAI no idoso: Desconhecem o estadiamento da DAI; Tratamento da DAI: Inclui dispositivos que evitam o contato das eliminações com a pele existindo dificuldades em diferenciar as categorias da lesão. Conclusão: Ausência de uniformização entre os enfermeiros acerca dos produtos que tratam a pele com DAI

Objective: Identifying the self-reported knowledge of nurses concerning the prevention, diagnosis, and treatment of incontinence-associated dermatitis (IAD) in hospitalized elderly patients, as well as proposing the construction of a nursing care protocol based on a flowchart. Methods: Descriptive and qualitative exploratory research through a semi-structured interview with hospital nurse professionals in the second semester of 2016. Interview data were analyzed through thematic analysis. Results: Presented in three categories: Elderly Admission and IAD Prevention: The majority of the clientele is elderly people, for whom the adoption of hygiene care and barrier application consist in prevention; IAD Diagnosis in elderly people: They do not know the staging of the IAD; IAD Treatment: It includes devices that avoid the contact of the eliminations with the skin, in which there have been difficulties in differentiating the injury categories. Conclusion: There was no consistency among the nurses about the products that should treat the skin with IAD

Efeito da pomada de óxido de zinco e da película de barreira não irritante na prevenção da dermatite associada à incontinência em idosos hospitalizados: ensaio clínico randomizado / Effect of zinc oxide ointment and non-irritant barrier film on the prevention of incontinence-associated dermatitis in hospitalized elderly: a randomized clinical trial

Observa-se na prática clínica pacientes internados com Dermatite Associada à Incontinência (DAI), uma inflamação cutânea que ocorre como consequência do contato entre a pele perineal, perigenital, perianal e áreas adjacentes com urina e fezes, além de epiderme com erosão e maceração. O cuidado com a prevenção deve ser estabelecido, mas pouco se sabe sobre esse cuidado. É necessário evitar ou minimizar a exposição a fatores causais e uma combinação de cuidados específicos da pele, como a limpeza da região, aplicação de produtos barreira. Normalmente, são utilizados sabão e água e é aplicado a pomada de óxido de zinco, um creme de barreira. No entanto, desde a década de 1990, uma película de barreira não irritante (PBNI), livre de álcool foi projetado para proteger a pele. O objetivo deste estudo foi comparar o efeito do uso de pomada de óxido de zinco e PBNI na prevenção de DAI em pacientes incontinentes internados em unidades de clínica médica. É um estudo experimental, do tipo ensaio clínico randomizado realizado em um hospital geral, de grande porte, público e de ensino. A população do estudo foi constituída por 114 pacientes idosos, que apresentavam eliminações urinárias e fecais em fralda descartável. Foram definidos três grupos de estudo, com 38 paciente em cada grupo: controle com o uso da higienização com água e sabão, intervenção I com a higienização e aplicação da pomada de óxido de zinco e intervenção II com higienização e aplicação do PBNI spray. Para a análise descritiva, foram utilizadas as distribuições de frequência simples, medidas de tendência central e medidas de variabilidade; para a avaliação do efeito das intervenções, o teste de regressão de Cox. Quanto ao efeito dos tratamentos sobre o risco de adquirir a DAI, identificou-se que os pacientes que receberam a intervenção II apresentaram menor risco (HR=0,54; p= 0,183) quando comparado ao grupo que recebeu intervenção I (HR=1,06; p=0,895) e ao grupo que recebeu somente a higienização. Contudo, não se encontrou diferença estatisticamente significativa entre os dois grupos de intervenção e o controle, não sendo possível afirmar qual a melhor intervenção. As variáveis que tiveram influência no aparecimento da DAI foram: dias de uso de tamanho adequado da fralda, número de dias de fezes pastosas, pacientes em risco nutricional e nível de saturação de oxigênio, sendo, portanto, fatores que devem ser monitorados pela enfermagem para evitar o surgimento do problema.(AU)

It is observed in clinical practice patients hospitalized with Incontinence-Associated Dermatitis (IAD), a cutaneous inflammation that occurs as a consequence of the contact between the perineal, perigenital, perianal skin and adjacent areas with urine and feces, as well as epidermis with erosion and maceration. Care with prevention should be established, but little is known about such care. It is necessary to avoid or minimize exposure to causative factors and a combination of specific skin care, such as cleaning the region, applying barrier products. Usually, soap and water are used and it is applied to zinc oxide ointment, a barrier cream. However, since the 1990s, a non-irritating barrier film (NIBF), alcohol-free was designed to protect the skin. The objective of this study was to compare the effect of the use of zinc oxide ointment and NIBF in the prevention of IAD in incontinent patients hospitalized in medical clinic units. It is an experimental study, of the type randomized clinical trial conducted in a general hospital, large, public and teaching. The study population consisted of 114 elderly patients, who had urinary and fecal eliminations in a disposable diaper. Three study groups were defined, with 38 patients in each group: control with the use of soap and water hygiene, intervention I with the hygiene and application of the zinc oxide ointment and intervention II with hygiene and application of NIBF spray. For the descriptive analysis, we used the simple frequency distributions, measures of central tendency and measures of variability; for the evaluation of the effect of the interventions, the Cox regression test. Regarding the effect of the treatments on the risk of acquiring the IAD, it was identified that the patients who received the intervention II had a lower risk (HR = 0.54; p = 0,183) when compared to the group that received intervention I (HR = 1.06, p = 0.895) and the group that received only the hygiene. However, no statistically significant difference was found between the two intervention groups and the control, and it was not possible to state the best intervention. The variables that influenced the appearance of IAD were: days of adequate diaper size, number of days of pasty stools, patients at nutritional risk and oxygen saturation level, and therefore, factors that should be monitored by nursing to prevent the problem from arising.

Efficacy of montmorillonite combined with oxygen in the treatment of neonatal diaper dermatitis / 中国生化药物杂志

Objective To observe the efficacy of montmorillonite combined with oxygen in the treatment of neonatal diaper dermatitis, and to provide the basis for clinical treatment. Methods Collected 100 cases of neonatal diaper dermatitis from January 2014 to January 2017 in our hospital. The patients were divided into observation group and control group according to the order of admission. After treatment, the observation group was given montmorillonite combined with oxygen therapy, the control group was given only oxygen treatment, compared the treatment effect of the two groups of patients. Results After treatment, the total effective rate of the observation group was 100％, the total effective rate of control group was 80％, there was significant difference between the two groups in the total effective rate of clinical treatment (P<0.05).The cure time was (116.20 ± 25.79) h in the observation group and (145.72 ± 24.88) h in the control group. The difference of the cure time between the two groups was statistically significant (P<0.05). In the observation group, the erythema was found in 42 children after treatment, and the area of erosion was obviously reduced before treatment, and the surface of the lesion was dry. After treatment for 5 days, 36 cases of mild to moderate diaper dermatitis were cured. After 7 days of treatment, children are cured. In the control group, 19 cases of mild diaper dermatitis were treated with erythema dermatitis . After treatment for 5 days, the area of hips in the 22 cases was smaller than that before treatment, and the lesion was dry. After 7 days, There was no significant improvement in erosion and or exudation. Conclusion Montmorillonite powder combined with oxygen treatment of neonatal diaper dermatitis is a significant effect, is the ideal treatment for neonatal diaper dermatitis.

Comparing the effects of Bentonite & Calendula on the improvement of infantile diaper dermatitis: A randomized controlled trial.

Background & objectives: Infantile diaper dermatitis is a common, acute inflammatory reaction of the skin around diaper among infants. This study was undertaken to compare the effect of topical application of Bentonite and Calendula creams on the improvement of infantile diaper dermatitis. Methods: This double blind randomized controlled trial was undertaken on 100 patients of infantile diaper dermatitis. The 100 participants were randomly assigned into two groups of 50 each, and were prescribed the coded medicine. The mothers were trained to apply the cream and level of improvement was judged by observing the affected area on the first visit and then after three days of receiving treatment. Results: The mean age of infants was 6.45±5.53 months in Calendula group and 7.35±6.28 months in Bentonite group. Overall, 88 per cent of lesions in the Bentonite group started improving in the first six hours while this rate was 54 per cent in Calendula group (P<0.001). The risk ratio for the improvement in the first six hours was 2.99 folds in the Bentonite group. Also, lesions in 86 per cent infants in the Bentonite group and 52 per cent in the Calendula group were completely improved in the first three days after treatment (P<0.001). Interpretation & conclusions: Our results showed that in comparison with Calendula, Bentonite had faster healing effect and was more effective on the improvement of infantile diaper dermatitis (IRCT ID: IRCT 2012112811593N1).

Effect of recombinant bovine basic fibroblast growth factors combined with new rehabilitative liquid on neonatal diaper dermatitis / 现代临床护理

Objective To investigate the effects of recombinant bovine basic fibroblast growth factors combined with new rehabilitative liquid on neonatal diaper dermatitis. Methods One hundred and twenty neotates with neonatal diaper dermatitis from August 2013 to July 2014 were randomly divided into the control group and experiment group, 60 cases in each group. The control group was treated with conventional care, while the observation group with recombinant bovine basic fibroblast growth factors combined with new rehabilitative liquid. The total effective rate and the treatment time were compared between the two groups. Result The total effective rate of the observation group was significantly higher than that of the control group (P<0.05) and the treatment time of the observation group was statistically significantly shorter than that of the control group (P<0.05). Conclusion Recombinant bovine basic fibroblast growth factors combined with new rehabilitative liquid is effective in the treatment of neonatal diaper dermatitis and it is worth promoting and using clinically.

Dermatologic Effects and Management of Urine and Feces on Infant and Adult Skin.

The effect of urine and feces on the skin is a contributing factor to the development of incontinent and diaper dermatitis. The objective of this research was to evaluate skin effects of a given urine or fecal sample on the donor child and/or an adult caregiver, both of whom would be exposed to the biological material in course of daily life. Methods: Urine was evaluated under a variety of experimental skin conditions: normal (N), compromised by tape stripping (C), hydrated by prolonged exposure to water via occlusive patch (H), and hydrated/compromised (H/C). After pre-treatment, sites were patched (3 times of 24-h each) with 0.5 ml infant urine, saline (negative control) or 0.3% sodium lauryl sulfate (SLS, positive control). Fecal material was evaluated using a 4-h patch followed by tape stripping of selected sites. Results: In the urine study, a single 24-h patch produced a significant elevation of pH compared to both the negative (saline) and positive (sodium lauryl sulfate) controls for all experimental skin conditions. Erythema produced by urine was intermediate between the negative and positive controls, and significantly different from the negative control on the N and C skin test sites. All three materials produced an increase in hydration of the skin. The single 4-h patch of fecal material produced significant erythema, a significant elevation of pH, and a significant increase in TEWL. Recovery to pre-treatment levels was observed by the next day on sites that received no further treatment. However, on sites patched with fecal material, then further compromised by tape stripping, recovery to pre-treatment levels for erythema and TEWL were delayed. Conclusion: These studies indicate that urine appears to have an inherent low level irritant property when in continuous contact with skin for 24 to 48 hours. With relatively short exposures of 4 hours fecal material causes visible erythema, increases in pH and TEWL, and decreases in stratum corneum resilience to the subsequent insult of tape stripping. Results re-inforce the utility of modern diapers and incontinent products, utilizing superabsorbent materials, to effectively absorb wetness, keeping skin dryer and minimizing adverse skin effects.

Sifiloide posterosivo de Sevestre-Jacquet y granuloma glúteo infantil: presentaciones inusuales y graves de una dermatitis irritativa del área del pañal. A propósito de tres casos / Posterosive syfiloid of Sevestre-Jacquet and granuloma gluteal infantile: unusual and serious presentations of an irritative dermatitis of the diaper area. A propos of three cases

Presentamos tres casos de dermatitis irritativa de la zona del pañal de aparición poco común, el eritema pápulo-erosivo de Sevestre-Jacquet y el granuloma glúteo infantil, que junto con la erupción pápulo-nodular pseudo-verrucosa perianal, son raras variedades morfológicas de esta frecuente entidad. Se consideran presentaciones patológicas de la dermatitis irritativa del área del pañal, con un amplio espectro de manifestaciones clínicas.

We present three cases of dermatitis of the diaper area of rare occurrence, papulo-erosive erythema of Sevestre-Jacquet and granuloma gluteale infantum, which together with the perianal pseudo-verrucous papules and nodules, are very rare morphological varieties of clinical manifestation of this common entity. These pathological presentations are considered as part of a wide spectrum of clinical manifestations of irritative dermatitis in the diaper area.

Quadro clínico e tratamento da dermatite da área das fraldas: parte II: [revisão] / Clinical presentation and treatment of diaper dermatitis: Part II: [revision]

A dermatite da área da fralda irritativa primária é a mais prevalente desse tipo, sendo provavelmente a afecção cutânea mais freqüente na primeira infância. Constitui fonte significativa de desconforto para a criança. O uso da fralda ocasiona aumento da temperatura e da umidade locais. Há conseqüente maceração da pele, que se torna mais susceptível à irritação ocasionada pelo contato prolongado da urina e das fezes. Freqüentemente surge infecção secundária por Candida albicans ou por bactérias como Bacillos faecallis, Proteus, Pseudomonas, Staphylococcus e Streptococcus. O uso de pós, óleos, sabões e pomadas irritantes agravam o quadro clínico. A melhor conduta é a prevenção que engloba um conjunto de medidas que têm como objetivos manter a superficie seca, limitar a mistura e dispersão da urina e das fezes, reduzir seu contato com a pele, evitar irritação e maceração, preservar a função de barreira cutânea e manter, sempre que possível, um pH ácido. O tratamento médico consiste em medidas simples, ajustadas de acordo com a gravidade e o tipo de dermatite.

Diaper irritant contact dermatitis is the most prevalent diaper dermatitis and, probably, the most common cause of cutaneous disease in infants. Wearing diapers causes over hydration and increase of local temperature and humidity. As a consequence, the skin becomes susceptible to friction from movement under the diaper. Occlusion, maceration and possibly Candida and bacteria may all play a role. Oils, soaps and powders can be irritant and aggravate the eruption. The best thing to do is prevention. Treatment is simple anddepends on dermatitis type and severity.

Diapers and Infant Skin Health / 아동간호학회지

Diaper dermatitis, or commonly called "diaper rash", is among the most prevalent cutaneous disorders of infancy and early childhood and important issue in nursing. The term itself is not diagnostic since it encompasses a variety of acute inflammatory reactions which are best regarded as a family of disorders arising from a combination of factors specifically attributable to the use of diapers. Intensive study of the rash process has shown that skin wetness and fecal enzyme activity are damaging to skin and lead to the development of diaper rash. This suggests that it is important to keep urine away from babies' skin, so that the skin remains as dry as possible and maintains its barrier function abilities. Controlling the urine will also minimize the mixing of urine and feces within the diaper, which helps prevent the increased activity of enzymes that attack the skin and cause irritation. Therefore, a diaper that keeps the skin drier and limits the mixing of urine and feces will help prevent the conditions that lead to diaper rash. Since their introduction about 35 years ago, disposable baby diapers have undergone many design and performance changes. In particular, the performance of diapers was advanced by the introduction of absorbent gel materials(AGMs) to provide advantages in skin care, dryness, and leakage protection. Especially, important was the introduction of AGM which increased the absorbent capacity of the diaper several fold and yielded marked reductions in the degree of skin hydration occurring under the diaper. Studies show not only drier skin but more stable skin pH and less dermatitis with AGM diapers than with home-laundered cloth diapers or single-use diapers without AGM. Minimizing diaper area skin wetness is important for managing and preventing diaper rash. To minimize wetness, parents should use super absorbent diapers, change them frequently, and gently clean the perineal area with each diaper change. In addition to the skin care benefits, disposable diapers are also better than cloth diapers in minimizing the risk of diarrhea outbreaks among infants and toddlers in day-care environments by reducing fecal contamination and minimizing the potential for transmission of gastro-intestinal tract disease in day-care settings. Furthermore, disposable diapers in the hospital provide nursing, health care, and other advantages over cloth diapers: convenience for nurses and parents, and better containment than cloth with less handling, decreasing the chance of spreading infections. These benefits extend from the care of infants in hospitals to children at home or in day care centers.

A case of granuloma gluteale infantum / 대한피부과학회지

Granuloma gluteale infantum may be considered a complication oi the primary irritant type of diaper dermatitis and a modern disease due to the change in tae are of the napkin area. Most patients were infants who had worn plastic diapers and were treated with fluorinated topical corticasteroid cream for their diaper dermatitis. The lesions comorise one or several, soft and reddish brown or livid purple nodules on the napkin area. We report a typical case of granuloma gluteale infantum in a 13-month old female who had been treated with topical cortieosteroid crearn for her diaper derniat;lis. The granuloma regressed spontaneously after withdrawl of the topical corticosteroid and restricted use of the occlusive plastic diaper.

A clinical and mycological study of diaper dermatitis / 대한피부과학회지

Diaper dermatitis is an infant dermatosis associated with the wearing of diapers, Despite of its high frequency in clinical pediatrics the clinical characteristics are not well described in the korean literatvre. We investigated the clinical and mycological characteritics of diaper dermatitis in 50 serial patients. Clinically diaper dermatitis was classified. into five categories,irritant contact derniatitis(ID), candidiasis(CD). combined rash of ID and CD(CR.), intertrigo, and miliari. Of 50 patients with diaper dermatitis, 18 had ID; 16, CI3; 10, CR; 5, intertrigo, and 1, miliaria, The mean age of patients with ID (11.8 months) was higher than that of patients with CD (4.0 months). Candida albicans(C. albicans) w is isolated from 25 patients with diaper dermatitis. The rate of positive cultures by clinical diagnosis was 130% in CD, 11.1% in ID, 60, 0% in CR, and 20.0% in intertrigo. C. albicons was isolated from 23 patients(82.1%) of patients with clinically suspected Ci") and 2 of 22 patients without the characteristic erythematous papulesThe presence of eryhematous papules was the most characteristic clinical feature of infection, Other candida species isolated from cut,aneous lesions were C. tropicalsis, C.'. parapsiolosis, and C. stellatoidea.