Ensino sobre dermatite associada à incontinência subsidiado pela metodologia da problematização / Teaching about incontinence-associated dermatitis informed by problematization methodology / La enseñanza sobre dermatitis asociada a la incontinencia subsidiada por la metodología de la problematización

Objetivo: avaliar de modo formativo um processo de intervenção educativa sobre dermatite associada à incontinência com profissionais de enfermagem de um hospital público. Método: estudo de intervenção educativa, com abordagem qualitativa, realizado em 2017, com sete profissionais da equipe de enfermagem do setor de clínica médica, de um hospital universitário da Região Centro-Oeste do Brasil. Investigada amostra não probabilística por conveniência. Os encontros foram gravados na sua totalidade em áudio e para tratamento dos dados utilizou-se a técnica de análise de conteúdo. Estudo aprovado por Comitê de Ética em Pesquisa. Resultados: nos depoimentos foram identificadas as seguintes categorias temáticas: curiosidade epistemológica, pesquisa/investigação, avaliação e alegria. Conclusão: os participantes relataram ter compreendido o tema, bem como afirmaram que a condução dos encontros ocorreu de forma eficiente, alegre e dinâmica. Destaca-se que os profissionais realizaram discussão sobre o problema, mobilizando o grupo para reflexão e mudança das práticas de cuidados em saúde.

Objective: to evaluate as training a process of educational intervention on incontinence-associated dermatitis with nursing professionals from a public hospital. Method: qualitative, educational intervention study conducted in 2017 with seven internal medicine nursing professionals at a university hospital in the Midwest region of Brazil, using a non-probabilistic convenience sample. The meetings were recorded in their entirety in audio, and the data were treated using the content analysis technique. The study was approved by the research ethics committee. Results: the following thematic categories were identified: epistemological curiosity, research/investigation, evaluation, and joy. Conclusion: the participants reported having understood the subject, and stated that the meetings were conducted efficiently, cheerfully and dynamically. Note that the professionals discussed the problem, which mobilized the group to think about and change health care practices.

Objetivo: evaluar de modo formativo un proceso de intervención educativa sobre dermatitis asociada a la incontinencia con profesionales de enfermería de un hospital público. Método: estudio de intervención educativa, con enfoque cualitativo, realizado en 2017, junto a siete profesionales del equipo de enfermería del sector de clínica médica, de un hospital universitario de la región del Centro Oeste de Brasil, siendo la muestra no probabilística por conveniencia. Todos los encuentros fueron grabados en audio y, para el tratamiento de los datos, se utilizó la técnica del análisis de contenido. Estudio aprobado por el Comité de Ética en Investigación. Resultados: por los testimonios, se identificaron las siguientes categorías temáticas: curiosidad epistemológica, encuesta/investigación, evaluación y alegría. Conclusión: los participantes relataron haber comprendido el tema, afirmaron que los encuentros fueron conducidos de forma eficiente, alegre y dinámica. Se resalta que los profesionales realizaron discusiones sobre el problema, movilizando al grupo para la reflexión y el cambio de las prácticas de cuidados en salud.

Development of a new diaper dermatitis-like reconstructed skin equivalent for testing children atopic dermatitis relieving cosmetics.

BACKGROUND: Diaper dermatitis (DD) is the most common acute inflammatory skin disease. It has a serious effect on children's and families' quality of life. We aimed to screen and evaluate the efficacy of different formulas for relieving the diaper dermatitis symptoms by developing a kind of diaper dermatitis-like reconstructed human skin equivalent in vitro. MATERIALS AND METHOD: We developed the human skin equivalent for diaper dermatitis with 0.2% Sodium lauryl sulfate (SLS). The diaper dermatitis-like human skin equivalent was characterized by high level of inflammation, such as overexpression of interleukin-1α (IL-1α), and impaired skin barrier. Four formulas with potential of anti-inflammation and promotion of skin barrier function were topically applied on the diaper dermatitis-like human skin equivalent surface. The afterward protection efficacy was evaluated by endpoints of IL-1α, tissue viability, and skin barrier function. RESULTS: The chemical irritant induced high release of IL-1α, impaired tissue viability, and skin barrier function. The cream prepared with potential of anti-inflammation and skin protection could effectively decrease and relive the impact of irritant with decreased level of IL-1α and the higher tissue viability than the placebo exposure. CONCLUSION: The results showed that diaper dermatitis-like human skin equivalent induced by SLS can mimic the skin irritation response of the diaper rash.

Safety evaluation for ingredients used in baby care products: Consideration of diaper rash.

Diaper rash can adversely impact the barrier properties of skin, with potential implications for increased absorption of chemicals through the skin, and this should be accounted for in any exposure assessment used in the safety evaluation of consumer products used in the diaper ("nappy") area. In the absence of a quantitative evaluation of the potential impact of diaper rash, a default assumption of 100% dermal penetration is often made for substances applied in the diaper area. We consider here the extent, duration and severity of diaper rash and make a recommendation for conservative assumptions to incorporate into exposure assessments. Using a time-weighted average, the potential impact of diaper rash is illustrated for substances that have varying degrees of absorption through healthy skin. Results confirm that for assessments that already assume dermal absorption of 50% or higher, there is no impact on the overall exposure assessment. For substances that have a very low degree of dermal penetration (1%) through healthy skin, the impact of rash is expected to be less-than four-fold. This can be refined with additional data as there are many examples of poorly absorbed compounds for which dermal penetration is still low even for compromised skin.

Skin pH and Transepidermal Water Loss Values in Children with Diaper Dermatitis in Ibadan, Nigeria.

BACKGROUND/OBJECTIVES: Diaper dermatitis (DD) is one of the most common skin conditions in infants and young children. Among the factors associated with greater frequency of DD are high skin pH and transepidermal water loss (TEWL). This study examined the prevalence of DD in healthy black children in Nigeria and evaluated the association between skin surface pH, TEWL, and DD in this population. METHODS: The study was cross-sectional in design and involved children younger than 2 years attending eight immunization clinics in Ibadan, Nigeria (N = 424). Children were recruited into the study using multistage sampling. Information collected included sociodemographic data, diapering and feeding practices. Physical examination of the diaper area was performed on each child to determine whether dermatitis was present. TEWL and skin pH were measured on the anterior chest wall and gluteal areas of each child. RESULTS: A total of 165 (38.9%) children had clinical evidence of DD. The mean skin pH and TEWL values were higher in the gluteal area than the anterior chest wall in all subjects, with or without dermatitis. The mean skin pH and TEWL were significantly higher on the anterior chest wall and in the gluteal area in children with DD. CONCLUSION: In Nigerian children with DD, skin pH and TEWL are higher in the diaper area and at an unaffected skin site.

Documentation of impaired epidermal barrier in mild and moderate diaper dermatitis in vivo using noninvasive methods.

The presence of irritants from feces and urine with the concurrent mechanical friction and occlusion creates an environment in the diapered area that renders the skin prone to diaper dermatitis. Besides being a source of discomfort to the infant, these skin irritations pose a risk of secondary infections. In this study, we used noninvasive in vivo techniques to define measurable parameters that correlate with diaper dermatitis pathophysiology. In 35 infants (16 with mild or moderate and 19 without diaper dermatitis) we compared skin of diapered areas afflicted with diaper dermatitis to lesion-free diapered sites and to skin outside the diapered area (thigh). Our findings show significantly elevated cutaneous erythema, pH, and hydration, with significantly compromised water barrier function in involved areas compared to nonlesional sites both within and outside the diapered area. Furthermore, skin pH in nonlesional diapered skin for the diaper dermatitis cohort was significantly higher compared to the nondiapered sites. These observations are consistent with the current understanding of pathological skin changes in diaper dermatitis. In this study, we demonstrate that noninvasive methods can document relevant parameters to diaper dermatitis in vivo.

Diaper area and disposable diapers.

Since the 1960s, cloth diapers have been replaced by disposable diapers. The evolution of healthier skin in the diaper area has been demonstrated in parallel to that of disposable diapers. The improvements of disposable diapers--fit, dryness, comfort--have been based on the understanding of factors playing a role in the development of diaper dermatitis.

Dermatite da área da fralda / Dermatitis of the diaper area

As autoras abordam o tema sempre atual da dermatite da área da fralda, analisando suas diferentes categorias e atualizando sua fisiopatologia, quadro clínico, diagnóstico diferencial, cuidados preventivos e tratamento.

Skin interaction with absorbent hygiene products.

Skin problems due to the use of absorbent hygiene products, such as diapers, incontinence pads, and feminine sanitary articles, are mostly due to climate or chafing discomfort. If these conditions are allowed to prevail, these may develop into an irritant contact dermatitis and eventually superficial skin infections. Skin humidity and aging skin are among the most significant predisposing and aggravating factors for dermatitis development. Improved product design features are believed to explain the decline in observed diaper dermatitis among infants. Where adult incontinence-related skin problems are concerned, it is very important to apply a holistic perspective to understand the influences due to the individual's incontinence level and skin condition, as well as the hygiene and skin care measures provided. Individuals with frail, sensitive skin or with skin diseases may preferably have to use high-quality products, equipped with superabsorbent polymers and water vapor-permeable back sheets, to minimize the risk of skin complications.

A review of the pathophysiology, prevention and treatment of irritant diaper dermatitis.

Irritant diaper dermatitis (IDD) is a form of contact dermatitis occurring in the diaper area as a consequence of disruption of the barrier function of the skin through prolonged contact with faeces and urine. Despite advances in diaper technology, it is a condition that still occurs regularly in young children. To combat this, barrier preparations can be used to protect the skin by coating the surface of the skin and/or by supplying lipids that can penetrate the intercellular spaces of the stratum corneum. In this review, the pathophysiology of IDD is outlined and its prevention and treatment are discussed, with particular reference to the role of emollients.

Diaper dermatitis--an overview.

Diaper dermatitis, also know as nappy rash, is an inflammation of the skin covered by nappy. It probably results due to an interaction of multiple factors like increased wetness, elevated pH due to urine, fecal enzymes and microorganisms under the nappy. It manifests as an erythematous rash occurring on the convex surfaces of skin under the nappy. Rashes resembling nappy dermatitis can also be caused by some diseases which may have serious systemic manifestations. Therefore it is essential to differentiate and treat them. The principle of treatment of diaper dermatitis is to keep the skin in the nappy area as dry as possible with frequent nappy change. The superabsorbent disposable diapers are known to reduce the incidence of diaper dermatitis. Barrier creams to protect the infant's skin and mild topical corticosteroids to reduce the inflammation are mainstays of therapy. The incidence and severity can be reduced by keeping the skin dry under the nappy and protected from irritants and infections.

Pigmented and hyperkeratotic napkin dermatitis: a liquid detergent irritant dermatitis.

BACKGROUND: Napkin or diaper dermatitis (DD) is an inflammatory cutaneous eruption limited to the diaper area and common in the first 2 years of life. A number of clinical variants of DD have been identified. OBJECTIVE: We report a new variant of DD characterized by papyraceous skin, brownish discoloration and predilection for the depth of folds. METHODS: 15 infants and toddlers affected by this peculiar type of DD were evaluated regarding duration, localization, morphology and evolution of their dermatosis. RESULTS: This variant of DD was mainly confined to the depth of inguinal and gluteal folds and invariably associated with severe xerosis with papyraceous and glazed skin. The patients were healthy and asymptomatic and all laboratory investigations performed were normal. All patients were frequently changed and thoroughly washed with synthetic detergents with acid pH. DD improved rapidly with reduced frequency of washing and discontinuation of liquid detergents. CONCLUSIONS: We conclude that this condition is a type of irritant contact dermatitis from excessive use of lipid acid detergents.

Association of skin wetness and pH with diaper dermatitis.

The strength of the association between diaper dermatitis and measurements of skin wetness and skin pH was evaluated by statistical analysis of four diaper trials involving 1601 infants. Although the strength of the association between skin wetness and diaper dermatitis was greater than that between skin pH and diaper dermatitis, increases in wetness and pH were both significantly associated with elevated mean grades for diaper dermatitis. The skin environment least likely to be associated with diaper dermatitis is one in which increases in both skin wetness and skin pH are minimized.

Diapering choices: a critical review of the issues.

Careful consideration is needed to determine which diapering system may be best suited to an institution's or individual's needs. A critical review of five issues--skin care, infection control, other health-related concerns, environmental and safety aspects, and time/cost issues--reveals that: (a) superabsorbent paper diapers reduce the incidence and severity of diaper dermatitis and control the spread of infection in caregiving surroundings; (b) cloth and paper diapers have different effects on the environment and neither type of diaper is clearly superior to the other; and (c) the cost of disposable diapers and reusable commercial-laundered diapers may be comparable, although home-laundered diapers are least expensive if the caregiver's labor is not considered.

Effect of oral zinc supplements on diaper rash in normal infants.

A total of 89 normal newborn infants received 10mg oral zinc supplements daily for 4 months and 90 others received a placebo. The zinc supplemented group had a significant reduction in the incidence of diaper rash, and they gained slightly more in height and weight, although the growth differences were not significant.

Dermatitis.

Dermatitis, the inflammatory response of the skin to various factors, may present in a variety of forms. Atopic dermatitis, contact dermatitis, nummular eczema, seborrhea, and stasis dermatitis, conditions with which the patient may present to the emergency department, either in the acute stage or with exacerbation of a chronic condition, are reviewed in this article.