MEDLINE Abstracts: Diaper Dermatitis
Management of diaper rash may not be a "hot topic" in medicine these days, but it is of considerable import to parents, pediatricians, and other caregivers. As a complement to our Dermatology Image of the Week (see Related Links) feature, we present a collection of MEDLINE abstracts of noteworthy articles on diaper dermatitis, compiled by the editors at Medscape Dermatology.
Ferrazzini G, Kaiser RR, Hirsig Cheng SK, et al
The microbiological basis of diaper dermatitis is not clearly elucidated, although a better knowledge of microbial colonisation can be of importance with regard to an adequate treatment.
To investigate the relevance of CANDIDA sp. and STAPHYLOCOCCUS AUREUS colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease.
Growth of CANDIDA sp. and S. AUREUS in the perianal, inguinal and oral regions was determined by positive/negative and semi-quantitative analysis in an open, multi-centre (n = 3) study. Forty-eight children with healthy skin and 28 with diaper dermatitis were analysed. The severity of diaper dermatitis was assessed using a total symptoms score.
Colonisation by CANDIDA sp. was significantly more frequent in children with diaper dermatitis as compared to those with healthy skin (perianal 75 vs. 19%; inguinal 50 vs. 10%; oral 68 vs. 25%, p < 0.0003), whereas colonisation by S. AUREUS at the 3 swab locations was not different (p > 0.34). There was a highly significant, positive correlation between severity of disease and extent of CANDIDA sp. colonisation at all swab locations.
Limited microbial colonisation in diaper dermatitis is of questionable relevance, but extensive colonisation seems to aggravate the symptoms; therefore, we suggest that semi-quantitative evaluation should be preferred to the positive/negative assessment for a differential diagnosis.
Railan D, Wilson JK, Feldman SR, Fleischer AB
Dermatol Online J. 2002;8(2):3 [serial online]
Clotrimazole-betamethasone dipropionate (C-BMV) is a fluorinated, high potency topical steroid that has been formulated with clotrimazole in the brand-named product, Lotrisone. The product is frequently used inappropriately in intertriginous areas, particularly in children. The following evaluates the use of this combination based upon a survey of 106 US-based pediatricians with at least two years post-residency, who attended the 1999 American Academy of Pediatrics. Of pediatricians who prescribe C-BMV, 23% prescribe it for diaper dermatitis. 11% of C-BMV prescriptions exceed the recommended duration of therapy. Only 18% of prescribing pediatricians correctly identify "Lotrisone" as a high potency steroid. There is no significant association between knowledge of C-BMV potency and frequency of use (p>.1). These self-reported data confirm and complement the findings of previous studies that used representative national data to assess the use of C-BMV. Pediatricians continue to utilize C-BMV in inappropriate settings, such as diaper dermatitis, regardless of their knowledge of the agent's potency. Our advice is to refrain from using high-potency steroids, such as C-BMV, in pediatric cases as there are more appropriate, safer alternatives with many fewer side effects.
Odio M, Streicher-Scott J, Hansen RC
Dermatol Nurs. 2001;13:107-12, 117-118, 121
The results of a series of four clinical studies demonstrated that disposable baby wipes were milder to the skin than use of a cotton washcloth and water, recognized as a "gold standard" for skin mildness. Importantly, the baby wipes caused no significant change from the baseline value in any of the skin parameters examined. This observation verified that the test wipes are minimally disruptive to the epidermal barrier and thus suitable for use on intact or compromised, irritated skin.
Guin JD, Kincannon J, Church FL
Am J Contact Dermat. 2001;12:189-192
Hand eczema can have complex causative or aggravating influences, and the pattern, history, and patch test data are helpful in identifying sources and antigen substitution.
We studied our patients with hand eczema associated with exposure to baby wipes for pattern and sensitivities.
Patient records over a 10-year period containing key words were reviewed for relevance of exposure, patch test data, and outcome.
A total of 6 women and 3 men with hand eczema were found to be allergic to (preservatives found in) different brands of moist towelettes used in diaper hygiene. Many were allergic to fragrance materials as well. The eruptions were mostly worse on the thumb and 2 adjacent fingers, with which the item was held. Five of the 9 were parents of infants, although no infant had a problem. Only 1 patient suspected the source. All improved with avoidance, although most had multiple other contact allergies, including corticosteroids.
Hand eczema in a grip-like pattern is good reason to inquire about baby wipes as a possible source, as most patients do not recognize that source even after undergoing patch tests.
Baldwin S, Odio MR, Haines SL, O'Connor RJ, Englehart JS, Lane AT
J Eur Acad Dermatol Venereol. 2001;15(suppl 1):5-11
Diaper dermatitis is a common childhood affliction. Aiming to help reduce the prevalence of this problem, we have advanced in our development of a novel diaper that delivers dermatological formulations to help protect the skin from over-hydration and irritation.
To determine the clinical benefits of a novel disposable diaper designed to deliver a zinc oxide and petrolatum-based formulation continuously to the skin during use.
All studies were independent, blinded, randomized clinical trials. Study A was conducted to confirm transfer of the zinc oxide/petrolatum (ZnO/Pet) formulation from the diaper to the child's skin during use. Children wore a single diaper for 3 h or multiple diapers for 24 h. After the use period, stratum corneum samples were taken from each child and analysed for ZnO/Pet. Study B evaluated the prevention of skin irritation and barrier damage from a standard skin irritant (SLS) in an adult arm model. Study C evaluated skin erythema and diaper rash in 268 infants over a 4-week usage period. One half of the infants used the ZnO/Pet diaper, while the other half used a control diaper that was identical except for the absence of the ZnO/Pet formulation.
The ointment formulation and ZnO transferred effectively from the diaper to the child's skin during product use. Transfer of ZnO increased from 4.2 microg/cm2 at 3 h to > 8 microg/cm2 at 24 h. Exposure to the formulations directly on adult skin prior to an irritant challenge was associated with up to a 3.5 reduction in skin barrier damage and skin erythema. Greatest reductions were seen for the ZnO containing formulations. Wearing of the formulation treated diaper was also associated with a significant reduction in skin erythema and diaper rash compared to the control product.
The results demonstrated the clinical benefits associated with continuous topical administration of a zinc oxide/petrolatum-based formulation by this novel diaper.
Ehretsmann C, Schaefer P, Adam R
J Eur Acad Dermatol Venereol. 2001;15(suppl 1):16-21
To confirm the safety and cutaneous tolerability of a new brand of baby wet wipes, we conducted the following clinical studies: (i) a double-blind in-use study in 102 infants over a period of 2 weeks, to compare skin tolerance of the wipes vs. water and a cleansing material (ii) a chamber scarification test on adults to assess the skin irritation potential of the baby wipe, and (iii) a 4-week clinical in-use study in 60 babies with atopic dermatitis, to confirm safety and skin tolerability in a sensitive skin subpopulation. In the clinical comparison with water and cleansing material, skin conditions were assessed visually for presence and severity of erythema and diaper dermatitis. The overall skin condition was not different in the group using wipes and in the group using only water and a cleansing material, indicating comparable skin mildness for both regimes. The chamber scarification test confirmed that the lotion contained in the wipe has a very low irritation potential, lower than that of a currently marketed baby wipe and comparable to that of water under occlusive patch test conditions. The good skin tolerance of the wipes was supported by the observations of a dermatologist in the clinical study in babies with atopic dermatitis. These data strongly support the suitability of the baby wipes tested in these studies for daily cleansing of the diapered area, even for infants with sensitive skin. These data also provide useful information regarding the comparative skin mildness of baby wipes and water.
J Eur Acad Dermatol Venereol. 2001;15(suppl 1):1-4
Irritant diaper dermatitis (IDD) is a common condition caused by the combination of wearing diapers, and incontinence of urine and faeces. The available evidence suggests that maceration of the stratum corneum by water increases susceptibility to frictional damage, and epidermal permeation of irritants. The most important irritants underlying IDD appear to be digestive enzymes persisting in faeces, particularly when these are activated by a high pH.
Medscape Dermatology. 2003;4(1) © 2003 Medscape
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