Neonatal diaper dermatitis
Introduction
Introduction to neonatal diaper dermatitis Neonatal diaper dermatitis is caused by the baby's buttocks being stimulated by urine, feces and untidy diapers. After rubbing, it causes redness of the skin. In severe cases, skin erosion and exfoliation may occur, and contact occurs in the diaper covering parts around the baby's anus and buttocks. Sexual dermatitis can even lead to sepsis. Neonatal diaper dermatitis occurs in infants, and skin lesions are often limited to areas that touch the diaper, such as the hips, the vulva, the lower abdomen, and the medial side of the femoral, the extent of which is comparable to that of the diaper. The skin lesions begin with mild flushing and swelling, and papules, blisters, erosions, etc. may occur during the course of the disease. Pustules and superficial ulcers may occur in patients with secondary infections. basic knowledge Sickness ratio: 0.05% Susceptible people: children Mode of infection: non-infectious Complications: urinary tract infections sepsis
Cause
Neonatal diaper dermatitis etiology
Diaper texture and replacement is not timely (20%):
Rough diapers or rubber cloth, tarpaulin, plastic, so that the local skin is often in a wet or immersed state, combined with the replacement is not timely, rubber or plastic can sometimes become a stimulating factor, induced the disease.
The diaper is not cleaned (25%):
Residual urine stains and feces are easily decomposed by parasitic bacteria to produce ammonia substances, which irritate the skin, dyes on the diapers, and residual soap can also be a stimulating factor that induces the disease.
Bacterial infection (20%):
Diapers can not be fully disinfected, bacteria accumulate, leading to pathogen infection.
Pathogenesis
Primary irritation diaper dermatitis
(1) Impregnation of the epidermis and weakening of the skin barrier function are the basis of the disease:
1 Hydration: Contamination of urine and urine, airtight diapers, clothing, etc., causing local skin temperature rise and increased sweating, causing the skin to be in a continuous humid environment, contributing to the occurrence of skin hydration, ultimately leading to impregnation of the epidermis .
2 friction: the friction between the rough diaper and the skin or the mutual friction between the skin and the skin, so that the impregnated epidermis is further damaged, and finally the barrier function of the epidermis is reduced and the environment of the bacterial breeding environment is formed, which is clinically found in the vulva of the child. The protruding parts, the friction areas such as the buttocks and the waist are prone to the disease.
(2) Secondary effects of a series of stimuli:
1 feces: long-term contamination of stool is the most susceptible to the disease of newborn skin, proteases and lipase in the stool, acidic or alkaline ingredients will further damage the skin barrier, alkaline feces are seen in those milk or high protein foods Children who are fed; acid stools are found in children with diarrhea caused by soymilk feeding or diarrhea caused by diarrhea. Because diarrhea contains more fatty acids in the dung, it is clinically found that once diarrhea is stopped, diaper dermatitis is also It will improve.
2 urine: ammonia in the urine (produced by ammonia-dissolving urea in the urine) and alkaline solution environment further damage the skin barrier and aggravate the skin's inflammatory response, the previous use of urine ammonia as the primary irritant of diaper dermatitis It is wrong. It is now believed that urine ammonia will only irritate the skin when the skin is damaged.
3 chemical irritants: frequent contact or use of chemical irritants such as deodorants, preservatives, bleaching agents in diapers, disinfectant soaps, creams and oils, are directly harmful to the skin of children, in addition, the skin of children Tolerance to many antifungal agents is also poor.
4 Candida albicans, excessive growth of anaerobic bacteria will further aggravate the skin's irritating response.
5 Temperature: Increased skin temperature in the diaper area will cause vasodilation and aggravate the skin's inflammatory response.
2. Candida diaper dermatitis
(1) Source of pathogen: The pathogen may be from the maternal birth canal with Candida vaginitis; breastfeeding should check the mother's mammary gland for mastitis; check whether the rubber teat is contaminated with Candida, if the child If there is repeated thrush in the mouth, the Candida in the diaper area comes from the gastrointestinal tract of the child.
(2) Ask the children about the recent history of frequent use of broad-spectrum antibiotics.
(3) Children with diarrhea are more likely to be infected with Candida.
(4) The diaper provides a very warm and humid growth environment for Candida, which can multiply on the surface of the skin.
(5) Most scholars believe that Candida is a secondary infection based on skin damage. It can penetrate the stratum corneum and activate the complement system through the bypass pathway to induce skin inflammation.
(6) Some scholars believe that the severity of diaper dermatitis and the length of the disease are not related to the type of diaper dermatitis, but related to the number of Candida albicans.
Prevention
Neonatal diaper dermatitis prevention
1. Texture requirements of diapers: White fine and soft cotton cloth, good hygroscopicity, foreign scholars advocate the use of disposable diapers containing acrylic gel material (AGM), because this diaper has good moisture absorption performance and is not irritating to the skin. A cloth dyed with an aniline dye is banned as a diaper.
2. Washing requirements of diapers: Do not advocate washing with disinfectant, wash the residual soap with water, and boil and disinfect if necessary.
3. Requirements for use of diapers: Change diapers frequently to avoid long-term contact with moist diapers. When changing diapers, apply non-irritating talcum powder to dry the skin; do not use rubber or plastic pads under the baby, or wrap in diapers. outer.
4. Diaper collection requirements: Banned diapers containing naphthalene or camphor to collect diapers.
Complication
Neonatal diaper dermatitis complications Complications, urinary tract infection, sepsis
Can be complicated by urinary tract infections, and even complicated by sepsis.
Symptom
Neonatal diaper dermatitis symptoms common symptoms papule baby buttocks red edema secondary infection scaly pustular candida infection
Occurred in milk infants, skin lesions are often limited to areas that touch the diaper, such as the buttocks, genital, lower abdomen and medial femoral, the range of which is comparable to the diaper cover, the skin lesions are initially mild flushing, swelling, Pimples, blisters, erosions, etc. may occur during the course of the disease, and pustules and superficial ulcers may occur in secondary infections.
Primary irritation diaper dermatitis
(1) This disease is the most common type of neonatal skin damage in the clinic.
(2) The most obvious damage is in the area where the diaper is in contact, such as the raised part of the buttocks, the inner side of the thigh, the scrotum, the haze or the labia majora.
(3) The skin that does not touch the wrinkles of the diaper is usually normal. Therefore, the affected skin lesions are often seen in the vulva of the baby girl and the normal wrinkled skin, showing a "W" shape.
(4) The basic damage is a smooth and shiny fusion erythema, sometimes like a scald; in addition, the affected part can also have red papules, edema and desquamation, and the appearance of a parchment-like wrinkle after the rash is cured, which is special. The meaning of the hint.
(5) The disease can be divided into several subtypes:
1 rubbing erythema type: more common, skin lesions can affect the wrinkles of the diaper area.
2 "Tide" labeling dermatitis: less common, the skin lesions are banded erythema appearing at the edge of the diaper, commonly found in the thigh or abdomen, which is due to the diaper's constant moisture and dryness (like ebb and flow), plus diapers The edge of the plastic is caused by excessive stimulation of the surrounding skin.
3Jacquet dermatitis: less common and more severe symptoms, manifested as papules, followed by erosion, and the formation of perforated edges and crater-like appearance of ulcers, these ulcers are also known as "ammonia-toxic ulcers", seen in those diapers used time In long-term children, in male children, ulcers can affect the glans and urethra, causing discomfort or difficulty in urinating.
2. Allergic contact diaper dermatitis
(1) More common in children under 2 years of age.
(2) The erythema in the diaper area, small blisters, and eczema-like changes after the blisters break. At the beginning, the blisters are not necessarily obvious.
(3) The disease is often complicated by primary irritative diaper dermatitis. Therefore, the distribution of the rash is the same as that of the former, that is, it is located in the protruding part covered by the diaper. However, the rash of the disease at the flexion site is also obvious, especially the used rash. The wrinkle site where the sensitizing external drug accumulates.
3. Candida diaper dermatitis
(1) In the diaper area, see the bright red spots with clear boundaries and scales on the surface.
(2) There are satellite-like flat papules and pustules around, and satellite-like damage often has ring-shaped scales.
(3) In severe cases, there may be large areas of erosion.
(4) involving the genitals, can see the fusion of erythema in the scrotum or labia.
(5) Psoriasis-like allergic rash: more common in children with diaper dermatitis with severe Candida infection, shortly after the beginning of treatment, bursilla-like scaly papules and plaques appear rapidly in the trunk area. The end is often not tired.
The rash may last for several days or weeks, and the culture of Candida is negative, which is currently considered to be an allergic reaction to Candida.
Examine
Examination of neonatal diaper dermatitis
1. Routine examination: occurs in infants, and the skin lesions are often limited to the parts that touch the diaper, such as the hip convex part, the genital area, the lower abdomen and the inner part of the femoral, and the range is equivalent to the diaper covering part. The skin lesions begin with mild flushing and swelling, and papules, blisters, erosions, etc. may occur during the course of the disease. Pustules and superficial ulcers may occur in patients with secondary infections.
2, laboratory inspection:
Blood routine examination: peripheral blood leukocyte count and neutrophil increase; concurrent urinary tract infection, urine routine examination: urine test showed increased white blood cells; concurrent sepsis blood culture: the result was positive.
3, simple diaper dermatitis does not need to do auxiliary examination.
Diagnosis
Diagnosis and differentiation of neonatal diaper dermatitis
diagnosis
According to the medical history and clinical manifestations, infants and young children who use diapers for 1 to 4 months can develop diaper dermatitis in the diaper area. The diaper dermatitis can be preliminarily dissolved in 5% KOH solution and observed under the microscope. To the pseudohyphae, hyphae or oval spores, can be further diagnosed as Candida diaper dermatitis, if a large number of pseudohyphae exist, indicating that Candida is in a pathogenic state, has diagnostic value.
Differential diagnosis
1. Seborrheic dermatitis in the diaper area: In addition to the rash in the groin area of the groin and the entire diaper area, the scalp, the back of the ear, the armpit and the neck also have a rash; the basic damage is a clear orange-red scaly plaque. The scaly is slightly yellowish and greasy, but there are no satellite-like lesions around the lesion, and most of the children recover naturally after 3 to 6 months.
2. Atopic dermatitis in the diaper area: The rash is similar to the primary irritating diaper dermatitis, but the rash is prolonged and difficult to heal, and there are mossy changes, scratches and scars, similar rashes in other parts, and Atopy in the family. Medical history.
3. Psoriasis in the diaper area: After hydration of the skin in this area, the scales on the surface of psoriasis damage are few, the local application of corticosteroid preparation is effective, the family has a history of psoriasis, and other parts of the body have Psoriasis damage, nails a little sag, etc., suggest the significance of the disease, otherwise the diagnosis is very difficult.
4. Infant perianal streptococcosis: caused by group A -hemolytic streptococcus, clinical manifestations of clear erythema in the perianal boundary, accompanied by mucosal fissures, children with pain, especially crying during the solution, solution It is difficult, and finally leads to delayed stool. Family members often have recurrent streptococcal pharyngitis. The cotton swabs in the affected area are cultured and can be used to suggest the disease.
5. Infant hip granuloma: The child had a history of primary irritating diaper dermatitis. On this basis, there was a solid, painless, reddish-brown to purple nodule with a size of 0.5 to 4.0 cm. The rash was located in the buttocks. In the medial and inferior abdomen, the cause of the disease is unknown, but after several weeks to several months, the rash eventually subsides.
6. Bullous impetigo in the diaper area: often caused by umbilical cord infection of phage group II Staphylococcus aureus, in the thigh, buttocks and lower abdomen of the child see multiple red flushing naked face, there is a honey yellow The skin of the suede is visible on the edge of the free pustule wall.
