Diaper Dermatitis
Introduction
Introduction to diaper dermatitis Diaperdermatitis, also known as erythemaglutealis, is a contact dermatitis that occurs in the diaper covering parts around the baby's anus and buttocks. This disease is similar to the "drug sore" and "monkey sputum" of traditional Chinese medicine. Xuan's drowning acne records: "The child of the month is bound by the hot and humid air in the legs of the cheeks and limbs of the hands and feet, often flooded with sores." Another example is the "Surgical Compression Book" monkey records: "It is a syndrome that children get more, from the anus or scrotum, the red glow, and gradually to the skin." The diaper is not cleaned, and the residual urine stains and feces are easily caused by the decomposition of the parasitic bacteria and the production of ammonia substances to stimulate the skin. May be related to other bacteria, such as Staphylococcus aureus, the experiment found that urine for 18h, can cause diaper dermatitis, while fresh urine does not occur. basic knowledge Probability ratio: 19% probability of neonatal illness Susceptible people: infants and young children Mode of infection: non-infectious Complications: bacterial infection
Cause
Causes of diaper dermatitis
Urine and feces produce irritating substances (35%):
Mainly due to irritating substances caused by urine and feces, mostly due to the diaper replacement is not timely, especially the use of plastic, rubber cloth, tarpaulin, so that the local skin is in a wet or immersed state. Can cause this disease.
The diaper is not cleaned (25%):
The diaper is not cleaned, and the residual urine stains and feces are easily caused by the decomposition of the parasitic bacteria and the production of ammonia substances to stimulate the skin. May be related to other bacteria, such as Staphylococcus aureus, the experiment found that urine for 18h, can cause diaper dermatitis, while fresh urine does not occur.
Stimulating factors on diapers (15%):
Dyes, residual soap, and rubber or plastic on diapers can sometimes be irritating factors that cause the disease.
Pathogenesis
The pathogenesis is not very clear, but some scholars believe that there is neither ammonia-producing bacteria (such as Proteus) in the urine, nor that ammonia can cause dermatitis, which may be related to other bacteria, such as Staphylococcus aureus. The experiment found that the urine was placed for 18 hours, which can cause diaper dermatitis, while fresh urine does not occur. Fecal enzymes such as proteases and lipases can cause irritation and increase pH, which is also beneficial for diaper dermatitis.
Chinese medicine believes that this disease is due to the delicate skin of children, urine and feces soaked for too long, causing the skin to flood and the disease.
Prevention
Diaper dermatitis prevention
1. Wash the buttocks, vulva and its surroundings with warm water every day, and use powdered skin care products as little as possible. Especially in summer, due to the strong secretion of sweat glands, powdery skin care products absorb water significantly, which can promote the formation of diaper dermatitis.
2. When changing the diaper, it should be rinsed with clean water. The diaper should be white and soft, and should not be wrapped around the diaper with a blanket or plastic cloth.
3. If the buttocks are stained with urine, they should be cleaned in time.
Complication
Diaper dermatitis complications Complications bacterial infection
The disease occurs in infancy, and it is not timely to change the diaper, causing the skin mucosa to be infected by the adhesion of urine and other filth, so the complications are mainly combined with bacterial infection. Because children's resistance is relatively low, or children with immunosuppressive agents, skin infections can penetrate the blood to cause systemic infections and induce sepsis, which should be brought to the attention of clinical pediatricians.
Symptom
Diaper dermatitis symptoms Common symptoms Pustular blister or bullae damage pimples vulva skin swelling
It mainly occurs in milk infants. The skin lesions are often limited to the parts that touch the diaper, such as the genital part of the buttocks, the lower abdomen and the medial part of the buttocks. The range is similar to that of the diaper. The skin lesions are mildly flushed and swollen. Gradually, papules, blisters, erosion and exudation can occur, and the path of disease is clear (Fig. 1). In the case of secondary bacteria or Candida infection, pustules and superficial ulcers may occur.
According to the history of contact with diaper in the baby diaper area, local dermatitis performance, general diagnosis is not difficult.
Examine
Examination of diaper dermatitis
Clinical skin examination: Skin lesions are often limited to areas that touch the diaper, such as the genital area of the buttocks, the lower abdomen, and the medial side of the femoral head. The range is comparable to that of the diaper cover. The skin lesions begin with mild flushing and swelling, and gradually appear papules, blisters, erosion and exudation, and the disease is clear.
Laboratory tests: blood routine, C-reactive protein, erythrocyte sedimentation rate, the total number of white blood cells increased, neutrophils increased significantly, and ESR increased.
Diagnosis
Diagnostic identification of diaper dermatitis
1. The incidence of rubella erythema is not limited to diaper covering, nor is it limited to babies, more common in the summer hot and humid season.
2. Candida erythema often has thrush in the mouth, the damage is not limited to the diaper coverage area, and the microscopic examination of the lesion can be found in hyphae and spores.
3. Skin eczema, local congestion is obvious, there may be light yellow liquid exudation, often accompanied by obvious skin itching.
4. The area of dermatitis is mainly on the buttocks and inner thighs.
5. The skin is rough and red. In severe cases, there are skin lesions such as macules, papules and small pustules, accompanied by exudate and rubbing.
