Irritant diaper dermatitis is a term for dermatitis caused by the occlusion, moisture, and friction produced by diapers or training pants. Once the skin barrier is compromised by this environment, secondary factors such as urinary ammonia, increased urine pH, fecal proteases and lipases, Candida albicans, bacterial overgrowth, and detergent soaps exacerbate the dermatitis.

There have been several reports in the literature of laxative use in infants leading to a severe irritant dermatitis. Laxative-induced diarrhea contained and occluded by a diaper can cause bullae and erosions.

Childhood physical and sexual abuse is a problem of epidemic proportions affecting children of all ages and economic and cultural backgrounds. Although awareness is increasing, it is often challenging to differentiate findings attributable to child abuse from other benign skin conditions. Perineal irritation and erythema are common causes for concern but are most likely due to irritant contact dermatitis (often caused by diapers), seborrheic dermatitis, poor hygiene, candidal lesions, and excoriation secondary to pruritus. However, severe diaper dermatitis may be a sign of physical neglect if associated with other risk factors. Additional physical findings increasing the possibility of abuse include marked subcutaneous wasting, xerosis due to chronic avitaminosis, and poor hygiene, often with associated pediculosis capitis.

Related topics: diaper dermatitis candidiasis, Jacquet erosive diaper dermatitis