Cause:Irritation by stool/urine
Pathophys:Debate if ammonia from urea-splitting bacteria plays a role, also about role of stool enzymes and bile salts; diaper dye (Peds 2005;116:e450)
Secondary candidiasis, may be associated w oral thrush, and often precipitated by antibiotic use, appears as confluent erythema w 1- to 3-mm satellite macule/papules
r/o seborrheic dermatitis, well-demarcated fiery red confluent rash, responds quickly to steroid creams; psoriatic diaper rash w shiny scales, responds slowly to topical steroids; staph infection often causing bullous impetigo lesions which resemble cigarette burns, rx w antibiotics; rarely Jacquet’s ulcers of vulva or buttocks, zinc deficiency (acrodermatitis enteropathica), herpes simplex, scabies, and Kawasaki’s disease (high fever)
Rx:
Frequent diaper change keeping skin clean and dry; avoid strong soaps; avoid occlusive diapering, put disposables on loosely and/or tear some holes in plastic, omit rubber pants; zinc oxide ointment helps protect skin (Vaseline, A+D ointment, Desitin, Eucerin, etc.)
Nystatin cream for monilial type (satellite lesions)