An atypical form of pediatric pityriasis rosea of the diaper area: Pityriasis marginata et circinata of Vidal.

Pityriasis rosea is a common, self-limited disease which in its typical form should not raise diagnostic doubts. Nevertheless, its atypical presentations can be a challenge for the clinician, and hence it is important to be aware of them. Recognition of these forms may enable a correct diagnosis to be made and avoid unnecessary procedures. We present two patients for whom we believe atypical PR was the most likely the diagnosis.

The effect of topical application of breast milk and education on preventing diaper dermatitis in children in rural areas.

PURPOSE: This study aimed to ascertain the impact of topical breast milk and diaper-area care instruction on the prevention of diaper dermatitis in rural settings. DESIGN AND METHODS: This was a pre-test-post-test experimental study with forty-eight 6-18-month-old children and their mothers. Participants were randomly assigned to three groups: two experimental groups (Group A: breast milk, Group B: education) and one control group (Group C). Data were collected face-to-face through home-visits. A sociodemographic data and diaper-area care practices form and The Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants were used for data collection. RESULTS: There was a statistically significant difference between children who used breast milk application to prevent dermatitis compared to children whose parents received diaper-area care education and a control group (p = 0.002). CONCLUSIONS: It was determined that topical breast milk application and diaper-area care education given to mothers were effective in preventing diaper dermatitis, and the application of breast milk was found to be safe and more effective than education. PRACTICE IMPLICATIONS: These findings highlight the need for education, information and practical solutions to prevent and appropriately treat diaper dermatitis.

Ulcerated diaper dermatitis: Child abuse mimicker.

Irritant diaper dermatitis is a common dermatologic problem among infants and young children. Severe erosive presentations, although uncommon, are diagnostically challenging and can mimic non-accidental trauma (NAT). Diagnosing inflicted injury and NAT where it does not exist can cause parental distress, yet failing to diagnose inflicted injury and NAT can result in re-injury. We describe three cases of severe erosive diaper dermatitis in pediatric patients aged 2-6 years that were initially concerning for inflicted scald burn or neglect.

[Diaper dermatitis is not always a harmless condition]. / Luierdermatitis is niet altijd onschuldig.

BACKGROUND: Diaper dermatitis in children is common and usually harmless. Often the cause is irritation, a secondary candida infection or eczema, for which treatment is simple and effective. In this paper we show that a therapy resistant diaper dermatitis can be the diagnostic clue to the rare but important diagnosis Langerhans cell histiocytosis (LCH). CASE DESCRIPTION: We saw a 14 months old girl with therapy resistant diaper dermatitis, skin abnormalities on the hairy scalp, fever, otorrhea and extensive lymphadenopathy. After a long period of doctor visits, skin biopsies confirmed the diagnosis of LCH. CONCLUSION: LCH is a rare condition that often manifests in the skin. LCH can manifest in different organs. Although skin involvement is sometimes considered as less relevant, cutaneous manifestations can be an important diagnostic clue. In this paper we show that diaper dermatitis is not always harmless: it can be a symptom of LCH.

Effects of Early Toilet Training and Elimination Communication With Respect to Diaper Types.

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P < .001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P < .001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P < .001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years.

The development of a nomogram model for the individualized prediction of diaper dermatitis risk in pediatric hospitalized children aged 1-36 months.

AIMS AND OBJECTIVE: To develop a nomogram model for individualized prediction of diaper dermatitis in pediatric hospitalized infants and toddlers aged 1-36 months. BACKGROUND: Diaper dermatitis is a common skin health problem in pediatrics, which brings pain and discomfort to the child. However, there is a scarcity of risk prediction tools for diaper dermatitis in infants and toddlers hospitalized in pediatrics. DESIGN: A cross-sectional study. METHODS: 210 cases each for caregivers and hospitalized children aged 1-36 months were selected as the research objects. A prediction nomogram model was established based on the risk factors according to the results of univariate analysis and multivariate logistic regression analysis. The predictive performance of the nomogram model was evaluated by discrimination and calibration. The clinical utility of the model was evaluated by decision curve analysis. This study was reported using the TRIPOD checklist. RESULTS: 41 hospitalized children with diaper dermatitis with a prevalence of 19.52%. The risk factors included: age in months, diarrhea, history of diaper dermatitis, without prophylactic application of buttock protection products, frequency of diaper change per day ≤6.6 times, and the level of caregivers' knowledge of infantile diaper dermatitis. The results showed that the C-index of the nomogram model was 0.891(95% CI: 0.832, 0.950), the calibration curve manifested a satisfactory consistency, and the net benefit was satisfactory. CONCLUSIONS: The nomogram has a good predictive ability and satisfactory clinical utility, which is useful for pediatric medical staff screening high-risk patients with diaper dermatitis. RELEVANCE TO CLINICAL PRACTICE: The prediction nomogram model can help pediatric medical staff to calculate the risk probability of diaper dermatitis in pediatrics, formulate interventions timely, and optimize pediatric DD standardized care protocols. NO PATIENT OR PUBLIC CONTRIBUTION: the children's caregivers enrolled in this study only for the data collection.

When "the runs" also burns: Case reports of severe diaper dermatitis in children with acute gastroenteritis mimicking scald burns.

Burns to the buttocks of a child are highly concerning for child abuse unless there is a clear history to support an alternative diagnosis. We report two cases of severe erosive diaper dermatitis presenting as buttocks and perineal burns caused by prolonged exposure to diarrheal stool. These cases underscore the importance of making the right diagnosis to avoid the undue psychosocial stress to families that comes with a mistaken diagnosis of inflicted injury, and further add to our understanding of diarrheal contact burns in the absence of laxative use.

Hydrocolloid dressing for the treatment of severe diaper dermatitis.

Diaper dermatitis is a common dermatosis that usually responds to adequate hygiene and topical treatment, but can be a therapeutic challenge. Continuous exposure to feces and urine can cause extensive erosions and pain. The use of hydrocolloid dressings may be helpful in keeping the skin isolated from stool and urine, reducing pain, and enabling skin lesions to heal. We explain an easy technique, utilizing stoma powder and a hydrocolloid dressing, for parents to apply at home.

Perivulvar Pseudoverrucous Papules and Nodules in a 4-Year-Old Girl with Urinary and Fecal Incontinence: Case Report.

BACKGROUND: Diaper (irritative) dermatitis is commonly encountered in pediatric practice. In severe cases, unusual lesions could mimic other vulvar dermatoses or sexually transmitted infections. CASE: A 4-year-old female refugee with urinary and fecal incontinence was referred for medicolegal evaluation (concern for childhood sexual abuse) due to presence of diffuse vulvar, perineal, and perianal lesions. Evaluation and histology were consistent with pseudoverrucous papules and nodules. Resolution occurred following frequent diaper changes and application of a protective ointment. DISCUSSION: Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.

The factors related to recovery time of diaper dermatitis in infants: A prospective observational study.

AIM: Prolonged diaper dermatitis may increase the risk of atopic dermatitis or infections. This prospective observational study aimed to investigate the prevalence, symptoms, areas, and recovery time of diaper dermatitis in infants aged 1 month and identify the factors related to recovery time. METHODS: Diaper dermatitis was defined as the presence of erythema, papules, dryness, erosion, or ulceration in the diapered area. Recovery time was days between infant's 1-month medical check-up and disappearance of symptoms. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used to identify the factors related to recovery time. RESULTS: Among 113 infants, 66 (58.4%) had diaper dermatitis, with erythema at the perianal area being the most common symptom. The median recovery time was 10 days. Four infants (6.1%) had diaper dermatitis for >5 weeks. Severity was not related to recovery time. CONCLUSIONS: A frequency of diaper changing of ≤10 times per day was a risk factor for recovery time. Our data showed recovery in approximately 10 days, regardless of severity at study enrollment. Health care professionals could inform parents of recovery time and recommended diaper changing frequency.

Potential Mechanisms of the Sparing of Atopic Dermatitis in the Diaper Region: A Scoping Review.

Atopic dermatitis (AD) is a chronic, inflammatory skin condition commonly affecting infants with notable sparing of the diaper region. Though sources anecdotally attribute this sparing to the physical barrier formed by the diaper and the subsequent retention of moisture, urine, sweat and feces, no studies have formally investigated the factors contributing to this sparing phenomenon. We performed a scoping literature review to investigate the factors involved in sparing of AD in the diaper region, namely humidity, scratching, urine, sweat, feces, and microbiome composition. A total of 130 papers met the inclusion criteria, and extracted data were analyzed in an iterative manner. Increased local humidity facilitates protective changes at the cellular level and offsets transepidermal water loss. Exposure to urea from both sweat and urine may contribute to improved moisturization of the skin through its natural humectant properties and ability to modulate gene expression. Introduction of flora in feces contributes to the generation of protective immune responses and outcompetes growth of pathogens such as Staphylococcus aureus. Finally, diapers physically prevent scratching, which directly interrupts the itch-scratch cycle classically implicated in AD. Our study reviews factors that may contribute to the sparing of AD in the diaper region in infants. A limitation to our findings is that the studies reviewed here explore the impacts of these factors on AD broadly, and not explicitly in the diaper region. Additional studies investigating this may further our understanding of AD pathogenesis and contribute to the development of effective therapeutics.

An Adaptation of the Skin Safety Model to Guide Diaper Dermatitis Research in the NICU.

Diaper dermatitis is an ever-present condition among infants. Little is known about the prevalence among infants in the NICU. This article presents an adaptation of the skin safety model (SSM) for the infant in the NICU. The concepts of the model were extracted, defined, and integrated into an adapted SSM model to provide a focus on the infant with diaper dermatitis in the intensive care setting. It is essential to include all factors of the infant's clinical characteristics and hospital experience in the modeling to accurately predict risk of skin vulnerability in this infant population.

Baby wipes and nappy rash - what is the relationship? A review.

Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.

[Sevestre-Jacquet posterosive syphilitic dermatitis associated with the use of reusable diapers: A clinical case]. / Dermatitis sifiloide posterosiva de Sevestre-Jacquet asociada al uso de pañales reutilizables: caso clínico.

BACKGROUND: Diaper dermatitis is a skin problem that has decreased with the development of new technologies in disposable diapers that prevent excessive moisture in the perianal region. The following clinical case shows the relationship between the use of cloth reusable diapers and the appearance of Jacquet erosive diaper dermatitis, a serious and rare complication of diaper dermatitis. CLINICAL CASE: We present the case of a 1-year-11-month-old patient, taken to the Dermatology department due to the presence of a lesion in the gluteal region. The mother reported the onset of the condition four months ago after the presence of semi-liquid stools. Localized dermatosis is observed on both lower limbs, affecting the genital region in the labia majora and the perianal region at the level of the intergluteal folds bilaterally and symmetrically. In the histopathological study, a posterosive Sevestre-Jacquet syphilid was diagnosed. CONCLUSION: Sevestre-Jacquet's posterosive syphilitic dermatitis is a rare dermatological condition and its risk of occurrence is greater due to the use of ecological cloth diapers.

INTRODUCCIÓN: la dermatitis de pañal es un problema cutáneo que ha disminuido con el desarrollo de nuevas tecnologías en los pañales desechables, los cuales impiden la humedad excesiva en la región perianal. En el siguiente caso clínico se muestra la relación entre el uso de pañales de tela y la aparición de dermatitis sifiloide posterosiva de Sevestre-Jaquet, una complicación grave y poco frecuente de la dermatitis de pañal. CASO CLÍNICO: presentamos el caso de una paciente de 1 año y 11 meses de edad, llevada a la consulta externa de Dermatología por la presencia de una lesión en la región glútea. La madre refirió inicio del padecimiento cuatro meses atrás y posterior a la presencia de evacuaciones semilíquidas. Se observa dermatosis localizada en ambos miembros inferiores, que afecta la región genital en labios mayores y región perianal a nivel de pliegues interglúteos de forma bilateral y simétrica. En el estudio histopatológico se emite el reporte diagnóstico de sifiloide posterosivo de Sevestre-Jacquet. CONCLUSIÓN: la dermatitis sifiloide posterosiva de Sevestre-Jacquet es una condición dermatológica poco frecuente y su riesgo de ocurrencia es mayor debido al uso de pañales ecológicos de tela.