A New Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants: Development and Validation.

BACKGROUND: One methodologic challenge in conducting research relating to diaper dermatitis (DD) is the absence of a reliable, objective, validated scale for assessing severity. The aim of this study was to develop and validate such a scale. METHODS: Scale development was based on experience of DD assessment and clinical and photographic data collected during the early stages of a randomized controlled trial of two DD treatments. The severity score is the sum of scores of four domains: severity of erythema and irritation, area with any DD, papules or pustules, and open skin. Possible scores range from 0 (clear skin) to 6 (extensive DD including intense erythema, papules or pustules, and open skin with damage to the dermis). Assessors used the scale to attribute severity scores using high-definition photographs of infants and babies with DD. Interrater reliability (IRR), internal consistency, and test-retest reliability were considered using intraclass correlation coefficients (ICCs), Cronbach's α, and Cohen κ statistics. RESULTS: IRR was very good between assessors familiar with the scale (ICC = 0.949, p < 0.001) and between assessors unfamiliar with the scale (ICC = 0.850, p < 0.001). Test-retest reliability at 2 weeks was good (κ = 0.603, p < 0.001). Cronbach's α for internal consistency was 0.702. Collation of photographs according to severity score revealed a visible continuum of DD severity, suggesting good construct validity. CONCLUSION: The newly developed scale appears to be easy to use, reliable, and effective in detecting increasing or lessening DD severity.

Cas 2015.3. Lactant de 9 mesos amb lesió perianal / No disponible

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[Evolution of disposable diapers and reduction of diaper dermatitis]. / Evolution des couches à usage unique et amélioration de l'état cutané des du siège enfants.

Keeping babies skin dry in the diaper environment, reducing leaking while increasing absorbency and preventing skin pH increase lead to provide better skin tolerance disposable diapers. During 80's, basic cellulose diapers were replaced by the introduction of absorbent gelling materials (AGM) and since 90's by microbreatheable diapers. These advances in diaper technology have contributed to the reduction of diaper dermatitis.

Diaper dermatitis and advances in diaper technology.

During the last decade, a number of technological innovations in disposable diaper designs and materials have aimed at reducing dermatological problems in the diaper area. The introduction of absorbent gelling materials led to a decrease in skin overhydration and made possible a more beneficial pH in the diaper area. A retrospective evaluation of clinical studies conducted before and after the introduction of absorbent gelling materials confirms that utilization of these materials has been associated with a marked reduction in the severity of diaper dermatitis. More recently, a novel diaper designed to deliver dermatological formulations to the skin also appears to improve the condition of diapered skin. Disposable wipes now are available that are nonirritating and suitable for use on damaged or broken skin. Ongoing innovative efforts in this area promise to further decrease the prevalence of diaper-associated dermatologic conditions.

[Diaper dermatitis. Classification, occurrence, causes, prevention and treatment]. / Bleiedermatitt. Klassifikasjon, forekomst, årsaker, forebygging og behandling.

Diaper dermatitis is a multifactorial dermatological disorder characterized by inflammation in the diaper area. About half of all babies and old people in need of care experience light dermatitis, while 20% have moderate and 5% severe dermatitis. Friction from the diaper, occlusion, irritation from faeces, ammonia, detergents, candida albicans, proteolytic and lipolytic enzymes and moisture deposited on the epidermis cause damage at the stratum corneum layer of the epidermis. Diaper dermatitis is caused by a combination of mostly irritant effects. Compounds that infiltrate the skin can aggravate the reaction to the damaged epidermis. The barrier function of epidermis must be restored in order to prevent and treat diaper dermatitis.

Classification of diaper dermatitis: an overview.

Several types of diaper dermatitis are discussed: generic diaper dermatitis is most common and involves a simple erythema and mild scaling of the gluteal crease, buttocks, thighs, and lower abdomen. Candidal diaper dermatitis involves clinically significant infection with Candida albicans and presents as a sharply marginated area of erythema with significant involvement of the anterior thighs, genital creases, abdomen, and genitalia. Noduloulcerative diaper dermatitis may develop in a small percentage of patients who have chronic diaper dermatitis, as large, raised erosions with rolled margins. The lesions are most noticeable on the prominent body parts-genitalia, abdomen, thighs, and buttocks. Infantile seborrheic dermatitis involves a distinctive pattern of inflammation that usually begins beneath the diaper as a sharply marginated area of erythema with satellite lesions. Within 1-2 weeks, lesions develop on the scalp, cheeks, arms, legs, and intertriginous parts of the body. Impetigo is common in the diaper area, particularly in the first 6 months of life and during the warmer summer season. The lesions are usually bullous and represent infection by Staphylococcus aureus. Folliculitis appears as small, perifollicular erythematous papules and pustules, usually on the buttocks, thigh and lower abdomen. It is common in the warm summer months and is usually caused by bacteria such as S. aureus. Intertrigo categorizes disease that does not fit into the above categories. Often the patient presents with simple erythema of the folds without pustules or induration. This probably represents irritation and low-grade infection. It is important for the clinician to be aware that many other diseases can have manifestations in the diaper area.(ABSTRACT TRUNCATED AT 250 WORDS)