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(Irritant) Diaper Dermatitis !!navigator!!

Basics

  • The most common form of diaper rash is a primary irritant dermatitis (Fig. 4.28), a type of eczematous dermatitis triggered by urine, feces, moisture, and occlusion (discussed in detail in Chapter 2: Neonatal and Infantile Eruptions).

  • Diaper dermatitis can first present as early as the first few weeks of life, has a peak incidence at 9 to 12 months, but can occur any time when diapers are worn.

  • Patients who have atopic dermatitis are more likely to develop ICD as a result of their inherent skin sensitivity and defective barrier function.

Lip Lickers Dermatitis !!navigator!!

Basics

  • Lip lickers dermatitis is an eczematous eruption on the lips and perioral skin that is caused by irritation from saliva due to an, often unconscious, licking habit.

Clinical Manifestations

  • Lip lickers dermatitis presents with dry, scaly lips and pink or hyperpigmented (in darker skin types) thin, scaly plaques, in a semicircular geometric shape on the upper and lower cutaneous portion of the lips (Fig. 4.29).

  • The distribution of the dermatitis reflects the licking motion.

  • The skin immediately adjacent to the mucosal lip is often spared.

  • The lips are dry and cracked. Sometimes fissures are present.

Diagnosis

  • The diagnosis is made from the clinical examination and by eliciting a history of lip licking.

Diagnosis-icon.jpg Differential Diagnosis

Allergic Cheilitis (Allergic Contact Dermatitis of the Lips)

  • Eczematous eruption is limited to the mucosal lips and the adjacent skin. Usually due to cosmetics, personal hygiene products or foods.

Atopic Cheilitis (Atopic Dermatitis of the Lips)

  • Eruption on mucosal lips—lips appear dry, pink and fissured.

  • Often there is other stigmata of atopic dermatitis, that is, circumoral pallor, Dennie-Morgan folds. Evidence of atopic dermatitis elsewhere on skin.

Management-icon.jpg Management

  • A low-potency (class 6 or 7) topical steroid such as hydrocortisone 2.5% ointment or desonide 0.05% ointment applied twice daily to the affected area can help clear the dermatitis.

  • A skin protectant or barrier ointment applied to the lips two to six times per day can help keep the lips moist and protect the skin from contact with saliva.

  • It is important to also attempt to stop the licking habit to prevent recurrence.

Juvenile Plantar Dermatosis !!navigator!!

Basics

  • Juvenile plantar dermatosis (JPD) is a common dermatosis of childhood seen on the plantar aspects of the soles and toes.

  • JPD is also called “sweaty sock dermatitis,” because it is triggered by sweat and friction and often worsens in the winter months when warm socks and closed shoes are worn.

Clinical Manifestations

  • JPD presents as a smooth, red, shiny well-demarcated patches with desquamative scaling on the balls of the feet and the toe pads. The eruption is often symmetric (Figs. 4.30 and 4.31).

  • Fissures may be present, which are often painful.

  • The interdigital web spaces are spared but the palms and finger pads may have similar lesions.

  • Usually asymptomatic, but occasionally can be itchy.

  • The eruption can wax and wane for some time but is a self-limiting condition.

Diagnosis

  • The diagnosis is made clinically.

Diagnosis-icon.jpg Differential Diagnosis

Tinea Pedis

  • Usually involves the interdigital spaces especially in between fourth and fifth toes.

  • KOH will be positive.

Palmoplantar Psoriasis

  • Plaques of psoriasis are more brightly pink and scale is drier and thicker.

Shoe Allergic Contact Dermatitis

  • Allergic contact dermatitis secondary to shoe components is usually seen on the dorsum of the foot.

  • ACD presents as a well-demarcated eczematous plaque in the area of skin where the shoe has contacted the skin.

Management-icon.jpg Management

  • Take measures to decrease sweating:

    • Use Zeasorb powder on feet and in shoes before wearing shoes, or

    • Apply aluminum chloride (hexahydrate) containing preparations (Hydrosal or Certain Dri) to the skin of the feet prior to wearing shoes, and

    • Avoid impermeable socks and shoes, instead wear thin all cotton socks and shoes made with breathable materials

  • Change socks frequently if wet to avoid overhydration of skin.

  • Ointments and/or acid-based emollients or keratolytics should be applied twice daily to help protect the skin and prevent irritation by sweat.

  • A medium to high potency (class 1 to 3) topical steroid such as mometasone 0.1% ointment applied twice daily can help alleviate the associated erythema and pruritus.

Outline