Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Novel 3D printed polysaccharide-based materials with prebiotic activity for potential treatment of diaper rash.

Diaper rash, mainly occurring as erythema and itching in the diaper area, causes considerable distress to infants and toddlers. Increasing evidence suggests that an unequal distribution of microorganisms on the skin contributes to the development of diaper dermatitis. Probiotic bacteria, like Staphylococcus epidermidis, are crucial for maintaining a healthy balance in the skin's microbiome, among others, through their fermentative metabolites, such as short-chain fatty acids. Using a defined prebiotic as a carbon source (e.g., as part of the diaper formulation) can selectively trigger the fermentation of probiotic bacteria. A proper material choice can reduce diaper rash incidence by diminishing the skin exposure to wetness and faeces. Using 3D printing, we fabricated carbon-rich materials for the top sheet layer of baby diapers that enhance the probiotic activity of S. epidermidis. The developed materials' printability, chemical composition, swelling ability, and degradation rate were analysed. In addition, microbiological tests evaluated their potential as a source of in situ short-chain fatty acid production. Finally, biocompatibility testing with skin cells evaluated their safety for potential use as part of diapers. The results demonstrate a cost-effective approach for producing novel materials that can tailor the ecological balance of the skin microflora and help treat diaper rash.

Traditional practices in the treatment of children with diaper dermatitis.

AIM: Traditions are cultural heritages, habits, knowledge, customs and behaviors that are passed from generation to generation and from society to society. In all societies, children are seen as the future of society. Knowledge from traditions is used in raising children. Traditional practices are often used for children in cases such as breastfeeding, salting, diaper rash, diarrhea and jaundice. The aim of this study is to determine traditional practices used in the treatment of children with diaper dermatitis. MATERIALS AND METHODS: The research was conducted descriptively between June and August 2023. 81 children with diaper dermatitis were included in the sample. In the study conducted in a single stage, data were collected with a personal information form and Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants Scale. RESULTS: The age of the children was 16.12 ± 0.97 months and the average score of the Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants Scale was 2.55 ± 0.14. It was determined that approximately half of the mothers received training on diaper dermatitis. It was determined that during diaper dermatitis, mothers used barrier cream containing zinc oxide at most 38.3% as a modern method, and olive oil at most 35.8% as a traditional method. CONCLUSION: It was determined that traditional methods that do not harm health are generally used in children with diaper dermatitis. It is important to inform mothers and healthcare professionals about traditional practices for children and to support practices that do not negatively affect health.

Microbiome: Role in Inflammatory Skin Diseases.

As the body's largest organ, the skin harbors a highly diverse microbiota, playing a crucial role in resisting foreign pathogens, nurturing the immune system, and metabolizing natural products. The dysregulation of human skin microbiota is implicated in immune dysregulation and inflammatory responses. This review delineates the microbial alterations and immune dysregulation features in common Inflammatory Skin Diseases (ISDs) such as psoriasis, rosacea, atopic dermatitis(AD), seborrheic dermatitis(SD), diaper dermatitis(DD), and Malassezia folliculitis(MF).The skin microbiota, a complex and evolving community, undergoes changes in composition and function that can compromise the skin microbial barrier. These alterations induce water loss and abnormal lipid metabolism, contributing to the onset of ISDs. Additionally, microorganisms release toxins, like Staphylococcus aureus secreted α toxins and proteases, which may dissolve the stratum corneum, impairing skin barrier function and allowing entry into the bloodstream. Microbes entering the bloodstream activate molecular signals, leading to immune disorders and subsequent skin inflammatory responses. For instance, Malassezia stimulates dendritic cells(DCs) to release IL-12 and IL-23, differentiating into a Th17 cell population and producing proinflammatory mediators such as IL-17, IL-22, TNF-α, and IFN-α.This review offers new insights into the role of the human skin microbiota in ISDs, paving the way for future skin microbiome-specific targeted therapies.

Infantile anogenital digitate keratoses.

Infantile anogenital digitate keratoses (IADK) represent a distinct and under-recognized pediatric condition of the perianal area of infants, significantly more frequent in males than females. The average age of onset is 3.2 months, and it is self-remitting by 2 years of age. Perianal spiny keratoses resistant to usual topical therapies are the hallmark of IADK. We present a series of three cases of IADK seen at the dermatology clinic of the CHU Sainte-Justine to raise awareness on this pediatric condition, and to prevent invasive workup.

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.

Perianal Pseudoverrucous Papules and Nodules in an Elderly Patient.

Pseudoverrucous papules and nodules is a reaction to irritation usually associated with urostomies. We report a case of perianal pseudoverrucous papules and nodules in an elderly patient who developed a characteristic diaper dermatitis after infrequent diaper change. The perianal papulonodular lesions improved after saline wet dressing and topical steroid application. These perianal pseudoverrucous papules and nodules indicate a unique type of irritant diaper dermatitis, which can be distinguished from Jacquet erosive diaper dermatitis and granuloma gluteale adultorum. Identifying this condition is important because pseudoverrucous papules and nodules can resemble more serious dermatoses, leading to unnecessary investigations being carried out.

Effects of argan spinosa oil in the treatment of diaper dermatitis in infants and toddlers: A quasi-experimental study.

Objectives: Diaper dermatitis (DD) is one of the most common dermatological disorders in children. Commonly used drugs for treatment have several adverse effects; therefore, assessment of safe therapeutic strategies is necessary. We, therefore, aimed at comparing the efficacy of argan spinosa oil and 1% hydrocortisone ointment on DD healing. Methods: A quasi-experimental study was conducted in Jordan on children 2 years old or younger with mild to severe DD. Initially, 73 participants were enrolled in the argan spinosa oil group, and 74 participants were enrolled in the 1% hydrocortisone ointment group. Participants were assigned to groups randomly after the baseline measurement of DD. Healing was measured on a 5-point scale on days 1, 3, and 7, through home visits. Data were analyzed with Fisher's exact test, the Mann-Whitney U test, and generalized estimating equation (GEE) models in SPSS version 25 software, with a significance level of p < 0.05. Results: Of the 147 enrolled children, 140 completed the study. A significant decrease in the DD grades was observed in both groups. After the exclusion of confounding factors, the GEE models revealed that children treated with argan spinosa oil were approximately 0.25 times less likely to have severe DD grades and to show faster improvement than children treated with 1% hydrocortisone (p < 0.025). Multiple logistic regression on the baseline data revealed that the use of barrier cream (OR: 0.35; 95% CI: 0.18, 0.72; p = 0.004) and a frequency of bathing one or fewer times per week (OR: 1.15; 95% CI: 0.65, 2.10; p = 0.002) predicted DD occurrence. Conclusion: Argan spinosa oil is more effective than 1% hydrocortisone in healing DD and might be used as a complementary treatment. However, further clinical trials on larger samples will be essential for confirming the results and making a reliable judgment. Trial registration: NCT04210674.

Measurement instruments to evaluate diaper dermatitis in children: Systematic review of measurement properties.

AIM: The aim of this study was to summarize and evaluate the empirical evidence on the measurement properties of diaper dermatitis (DD) measurement instruments in children. DESIGN: Systematic review. METHODS: MEDLINE, CINAHL and EMBASE were systematically searched until 14 June 2021. Citation searching was conducted in Scopus. The risk of bias, the reported measurement properties and the quality of evidence were evaluated using the COSMIN framework. The reporting follows the PRISMA 2020 statement. RESULTS: We identified 1200 records in the databases and 108 records during citation searching and included four studies describing three measurement instruments for DD in children and their measurement properties. We considered the content validity inconsistent for all three instruments. The study authors reported internal consistency, reliability and construct validity for one instrument. We rated the quality of evidence from very low to moderate.

Jacquet erosive diaper dermatitis in a child with COVID-19.

Since the start of the COVID-19 pandemic, several reports around the world indicated that the novel coronavirus could be associated with specific dermatologic manifestations. Among earlier articles, encountered features included erythematous maculopapular exanthems, chilblains-like acral skin lesions, vesicular, and urticarial rashes. We describe the first case of Jacquet erosive diaper dermatitis in a 17-month-old girl with a confirmed COVID-19 infection. This article may serve to expand the knowledge of the diverse clinical features of COVID-19 infection, particularly among the pediatric population.

Pediatricians' Knowledge, Attitudes, and Therapeutic Approaches Regarding Diaper Dermatitis: A Common Condition with Many Different Practices.

Background: Diaper dermatitis is one of the most common skin diseases in early childhood. The prevalence of diaper dermatitis varies between 7% and 35% depending on population and age groups. There may be some differences among the pediatricians about treatment approaches to this common skin condition. Aim: The purpose of this study is to evaluate the management strategies of pediatricians for diaper dermatitis. Methods: The questionnaire-based cross-sectional study was conducted between September and December 2021. The questionnaire which contained 21 items aimed to investigate the approaches of pediatricians to diaper dermatitis treatment, follow-up and prevention strategies. Results: A total of 217 pediatricians (59.4% female, median age 40.0 years) practicing in 32 different provinces of Turkey completed the questionnaire. The most preferred medical treatments in the first visit of children with diaper dermatitis, in respect of frequency, were zinc oxide, panthenol/dexpanthenol, and hamamelis virginiana extract (70.9%, 36.9%, 33.6% respectively). If there was no response to the first-line treatment in the control examination, the treatment was rearranged by adding an antifungal creams, topical low-potency corticosteroids, and/or high concentration zinc oxide creams (67.7%, 57.6%, 28.6%, respectively). Most cases were referred to a dermatologist if these treatments were not effective in the control visits of patients. Conclusion: Although pediatricians often prefer topical barrier creams for the treatment of diaper dermatitis, options may change depending on the severity of the lesions or the treatment response to the first-line topical treatments.

Skin assessments and interventions for maintaining skin integrity in nursing practice: An umbrella review.

BACKGROUND: Daily skin care routines are fundamental aspects of clinical nursing practice. Providing skin care, including skin cleansing and application of leave-on products have substantial impact on the prevention and treatment of a number of skin conditions. There are hundreds of individual studies about skin risks, classifications, skin conditions, prevention and treatment. OBJECTIVE: To summarise the overall evidence regarding 1) risk factors associated with xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 2) the performance of diagnostic tests and/or classifications addressing the severity and/or signs and symptoms of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears, 3) the effects of skin cleansing/care interventions for the maintenance and promotion of skin integrity in all age groups, 4) effects of skin cleansing/care interventions for the prevention of xerosis cutis, incontinence-associated dermatitis/diaper dermatitis, intertrigo, skin tears in all age groups. DESIGN: Umbrella review. DATA SOURCES: A systematic search in MEDLINE and Embase (via OvidSP), Cochrane and Epistemonikos was conducted. Reference lists and experts were consulted for potentially missed reviews. REVIEW METHODS: Two reviewers screened titles/abstracts and full-texts independently. After rating the risk of bias only low to high overall confidence (AMSTAR 2) and low risk of bias (ROBIS) reviews were included. RESULTS: Twelve systematic reviews were included. Due to substantial heterogeneity regarding study designs, methods, and outcomes all authors presented findings in a narrative synthesis. The validity and reliability of the International Skin Tear Advisory Panel classification is supported by moderate quality evidence, and the reliability and criterion validity for Skin Tear Audit Research were rated insufficient. Overall, review results indicate that structured skin care programs are preferable to unstructured skin care with classic soap and water for maintaining skin integrity in general, preventing skin tears, and to prevent and treat xerosis cutis and incontinence-associated dermatitis. All reviews focusing on leave-on products for the prevention and treatment of incontinence-associated dermatitis and diaper dermatitis indicate the effectiveness of barrier films or lipophilic leave-on products in adults, elderly people and paediatric care, but could not establish the superiority of any product. CONCLUSIONS: The majority of systematic reviews in the field of skin care is at high risk of bias and should not be used for evidence-based practice. Overall, evidence indicates, that structured skin care programs containing low-irritating cleansers and application of leave-on products are beneficial to maintain skin integrity and prevent skin damage across a wide range of different skin conditions across the life span.

Evaluation of a 5% dexpanthenol-containing ointment for the treatment of infant irritant diaper dermatitis through the lens of the caregiver-A real-world data observational study.

Background and Aims: Irritant diaper dermatitis (IDD) is very common in infants and usually managed by the caregiver. Dexpanthenol-containing ointment (DCO) is a decades-long established product that has demonstrated efficacy and tolerability in the treatment and prevention of infant IDD in controlled clinical settings. The aim of this study was to evaluate the effectiveness of DCO in the treatment of infant IDD from the perspective of the caregiver by collecting data not explored in clinical trials, such as infant quality of life and the speed of action. Methods: A retrospective observational real-world data (RWD) study was conducted with French adult caregivers who had used a DCO to treat IDD in their infants within the past 6 months and consented to participate to the study completed a web-based survey answering questions regarding the severity of their infants' symptoms (intensity/extent of redness and discomfort, rated using Likert scales) before and after DCO application. The speed of onset of symptom relief and product acceptability were also collected. Results: A total of 500 caregivers of 564 infants completed the survey. Of these, 80% reported that DCO visibly treats IDD. In terms of speed of action, 83% declared that the first signs of symptom relief appeared after 1 day of application and 78% reported full symptom resolution within 2 days of application. Additionally, ≥77% of caregivers agreed that DCO provided overnight relief from the discomfort caused by IDD and reduced sleep disturbance in their children. Finally, 85% of caregivers declared being satisfied with the product overall and considered the product pleasant to use. Conclusion: This evidence from caregivers' experience confirms that DCO can be considered an adequate medication to self-manage IDD episode as it provides rapid relief of the signs and symptoms of inflammation, while by being pleasant to be use.

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.

Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review.

RATIONALE: Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment. OBJECTIVE: The study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD. METHODS: A systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search. RESULTS: Of the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD. CONCLUSIONS: These findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.

Bioactive tri-component nanofibers from cellulose acetate/lignin//N-vanillidene-phenylthiazole copper-(II) complex for potential diaper dermatitis control.

Current research targets innovative medical textiles of nanofibrous nature and antibacterial activity to prevent diaper dermatitis. The work is based on electrospun nanofibers from cellulose acetate (CA) and lignin (Lig) polymers. A series of new copper complexes were synthesized and loaded to the CA/Lig solution mix then subjected to electrospinning, giving rise to the tricomponent bioactive mats CA/Lig/Cu-complex. The surface morphology of electrospun nanofiber mats was smooth and homogenous as the concentration of lignin increased in the mixture. The incorporation of lignin improved the electrospinnability of the cellulose acetate; however, it increased the fiber diameter. The water contact angle, absorption underload were significantly improved as lignin content increased. The incorporation of Cu-complex in electrospun CA and CA/Lig fiber mats occurred without any substantial change in the surface morphology, indicating well encapsulation of the complex. The electrospun mats were active against Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus epidermidis, and Streptococcus faecalis. The cytotoxicity, protein leakage, and biological results, together with the above studies, would advocate copper complex loaded CA/Lig nanofibers as a potential candidate for hygienic applications.