Title: GZ / The Grenz Zone Season 2 / 20 Diaper Dermatitis
Tags: GZ DermnetNZ

Q: Diaper dermatitis is caused by a combination of [...] and [acidic or alkaline] pH of waste material
A: mechanical forces; alkaline

Q: Normal skin pH ranges from [...], which is protective. Under a more alkaline environment, the skin is more prone to irritants and Candida, which causes diaper dermatitis
A: 4 to 7

The differential diagnosis for diaper dermatitis can be remembered by SCAMP:
S: Seborrheic dermatitis
C: Candida or Contact dermatitis
A: Atopic dermatitis or Acrodermatitis enteropathica
M: Miliaria
P: Psoriasis or Perianal strep
Back Extra: Other differentials include: Langerhans cell histiocytosis, granuloma gluteal infantum, Kawasaki disease
Acrodermatitis enteropathica: rare genetic disorder of zinc metabolism that is characterised by the triad of dermatitis, diarrhea, and alopecia

Q: Seborrheic Dermatitis presents in the diaper area as a salmon pink dermatitis with coexisting [common infant seb derm finding]
A: cradle cap
Back Extra: Treatment consists of selenium sulfide and topical antifungals (ketoconazole or ciclopirox)

Q: Candida diaper dermatitis presents as bright red erythema WITH involvement of the [...] and satellite papules and pustules
A: skin folds
Back Extra: May also have thrush & hx of recent antibiotic use. Treatment consists of topical nystatin or azoles.

Q: Irritant contact dermatitis in the diaper area affects the convex (outside) areas of the vulva, scrotum, and buttocks [with or without] involvement of the skin folds
A: WITHOUT
Back Extra: Spares the folds because irritants like urine and stool cannot reach the areas where skin is touching skin. Treatment consists of diaper hygiene and hydrocortisone 2.5% 2-3x daily

Q: Allergic contact dermatitis can be caused by [specific substance] in the diaper elastic or methylisothiazinone in baby wipes
A: rubber

Q: [...] can rarely present in the diaper area and presents as hyperlinearity, erythema, and excoriations with lesions elsewhere in the body. Will also have a personal or family history of atopy
A: Atopic dermatitis

Q: [...] can present in the diaper area and is caused by the obstruction of sweat ducts under hot and occlusive environments
A: Miliaria
Back Extra: Can be subdivided into 3 types: miliaria crystallina, miliaria rubra pilaris, miliaria pustulosa. Treatment consists of avoiding overheating and occlusion, cooler baths, and using fans to cool
Miliaria crystallina: clear, pinpoint vesicles ona sea of scales. Most superficial with blockage of sweat duct in stratum corneum
Miliaria rubra pilaris: erythematous papules. Sweat duct blockage deeper in the epidermis
Miliaria pustulosa: more pustular lesions. Even deeper blockage of sweat duct

Q: Psoriasis in the diaper area presents as [poor or sharp] demarcated, red or pink plaques without the classic silvery scale and involves the skin folds
A: sharply
Back Extra: No silvery scale is seen due to the excessive moisture from occlusive diaper
Treatment consists of hydrocortisone 2.5% 2-3x daily for short term use and topical tacrolimus for long term use

Q: [...] presents as sharply-demarcated redness, pain, and pruritis around the anus that heals with desquamation
A: Perianal dermatitis
Back Extra: Caused by group A streptococcus. Treatment consists of topical mupirocin or oral amoxicillin

Q: [...] is an inherited or acquired zinc deficiency that presents as erythema, pustules, and crusted patches or plaques in the diaper area, perioral region, and acral areas (hands and feet)
A: Acrodermatitis enteropathica
Back Extra: Triad of dermatitis, diarrhea, and alopecia. Treatment consists of zinc supplementation

Q: Langerhans Cell Histiocytosis presents as [color] crusted papules in the seborrheic distribution of the scalp and diaper areas
A: yellow-brown
Back Extra: These lesions are more petechial or purpuric, may have lymphadenopathy, and respond minimally to treatment for other causes of diaper dermatitis.
4 variants of LCH:
Letterer-Siwe: < 2 year old with poor prognosis
Hand-Schuller-Christian Syndrome: 2-6 year old with DEB (diabetes insipidus, exopthalamos, and osteolytic bone lesions)
Congenital self-healing reticulohistiocytosis of Hashimoto-Pritzker: skin limited form present at birth
Eosinophilic granuloma: > 7 year old with localized LCH skin lesions and asymptomatic bone lesions

Q: [...] presents as firm, erythematous or violaceous nodules in the diaper area
A: Granuloma gluteale infantum
Back Extra: The "granuloma" in the name is a misnomer because there are no granulomas on histology