Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Novel 3D printed polysaccharide-based materials with prebiotic activity for potential treatment of diaper rash.

Diaper rash, mainly occurring as erythema and itching in the diaper area, causes considerable distress to infants and toddlers. Increasing evidence suggests that an unequal distribution of microorganisms on the skin contributes to the development of diaper dermatitis. Probiotic bacteria, like Staphylococcus epidermidis, are crucial for maintaining a healthy balance in the skin's microbiome, among others, through their fermentative metabolites, such as short-chain fatty acids. Using a defined prebiotic as a carbon source (e.g., as part of the diaper formulation) can selectively trigger the fermentation of probiotic bacteria. A proper material choice can reduce diaper rash incidence by diminishing the skin exposure to wetness and faeces. Using 3D printing, we fabricated carbon-rich materials for the top sheet layer of baby diapers that enhance the probiotic activity of S. epidermidis. The developed materials' printability, chemical composition, swelling ability, and degradation rate were analysed. In addition, microbiological tests evaluated their potential as a source of in situ short-chain fatty acid production. Finally, biocompatibility testing with skin cells evaluated their safety for potential use as part of diapers. The results demonstrate a cost-effective approach for producing novel materials that can tailor the ecological balance of the skin microflora and help treat diaper rash.

An atypical form of pediatric pityriasis rosea of the diaper area: Pityriasis marginata et circinata of Vidal.

Pityriasis rosea is a common, self-limited disease which in its typical form should not raise diagnostic doubts. Nevertheless, its atypical presentations can be a challenge for the clinician, and hence it is important to be aware of them. Recognition of these forms may enable a correct diagnosis to be made and avoid unnecessary procedures. We present two patients for whom we believe atypical PR was the most likely the diagnosis.

Traditional practices in the treatment of children with diaper dermatitis.

AIM: Traditions are cultural heritages, habits, knowledge, customs and behaviors that are passed from generation to generation and from society to society. In all societies, children are seen as the future of society. Knowledge from traditions is used in raising children. Traditional practices are often used for children in cases such as breastfeeding, salting, diaper rash, diarrhea and jaundice. The aim of this study is to determine traditional practices used in the treatment of children with diaper dermatitis. MATERIALS AND METHODS: The research was conducted descriptively between June and August 2023. 81 children with diaper dermatitis were included in the sample. In the study conducted in a single stage, data were collected with a personal information form and Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants Scale. RESULTS: The age of the children was 16.12 ± 0.97 months and the average score of the Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants Scale was 2.55 ± 0.14. It was determined that approximately half of the mothers received training on diaper dermatitis. It was determined that during diaper dermatitis, mothers used barrier cream containing zinc oxide at most 38.3% as a modern method, and olive oil at most 35.8% as a traditional method. CONCLUSION: It was determined that traditional methods that do not harm health are generally used in children with diaper dermatitis. It is important to inform mothers and healthcare professionals about traditional practices for children and to support practices that do not negatively affect health.

Topical Use of Human Milk in the Neonatal Intensive Care Unit: An Integrative Review.

BACKGROUND: Research has shown that the bioactive components in human milk could demonstrate efficacy when applied topically. One common neonatal skin issue is diaper dermatitis (DD). DD treatment and prevention guidelines often lack the inclusion of topical human milk as a viable option. PURPOSE: To analyze the safety and efficacy of topical human milk application as a means to support future research of human milk as a topical treatment for DD. DATA SOURCES: Google Scholar, CINAHL, PubMed, and Cochrane. STUDY SELECTION: The search was limited to articles published between 2011 and 2023 in the English language. Disqualifying characteristics included nonhuman subjects, literature reviews, inability to obtain articles, and non-peer-reviewed articles. DATA EXTRACTION: For Google Scholar, the search terms "human milk OR breast milk" and "topical" were used. For CINAHL, PubMed, and Cochrane, the search terms "human milk OR chest milk OR breast milk OR donor milk" and "topical" were used. Quantitative significance was defined by a P value of less than .05. RESULTS: The search yielded 20 articles. The results of the review demonstrate that topical human milk application is a safe and effective topical treatment to skin integrity/inflammatory issues such as DD. It also identified that caregivers will likely show positive regard to the treatment, promoting its acceptance. IMPLICATIONS FOR PRACTICE AND RESEARCH: The results provide evidence to support methodologic development for human milk application for the prevention and treatment of DD. Further studies can use the results to develop protocols that investigate the effects of human milk application.

The effect of topical application of breast milk and education on preventing diaper dermatitis in children in rural areas.

PURPOSE: This study aimed to ascertain the impact of topical breast milk and diaper-area care instruction on the prevention of diaper dermatitis in rural settings. DESIGN AND METHODS: This was a pre-test-post-test experimental study with forty-eight 6-18-month-old children and their mothers. Participants were randomly assigned to three groups: two experimental groups (Group A: breast milk, Group B: education) and one control group (Group C). Data were collected face-to-face through home-visits. A sociodemographic data and diaper-area care practices form and The Scale for Assessing the Severity of Uncomplicated Diaper Dermatitis in Infants were used for data collection. RESULTS: There was a statistically significant difference between children who used breast milk application to prevent dermatitis compared to children whose parents received diaper-area care education and a control group (p = 0.002). CONCLUSIONS: It was determined that topical breast milk application and diaper-area care education given to mothers were effective in preventing diaper dermatitis, and the application of breast milk was found to be safe and more effective than education. PRACTICE IMPLICATIONS: These findings highlight the need for education, information and practical solutions to prevent and appropriately treat diaper dermatitis.

Ulcerated diaper dermatitis: Child abuse mimicker.

Irritant diaper dermatitis is a common dermatologic problem among infants and young children. Severe erosive presentations, although uncommon, are diagnostically challenging and can mimic non-accidental trauma (NAT). Diagnosing inflicted injury and NAT where it does not exist can cause parental distress, yet failing to diagnose inflicted injury and NAT can result in re-injury. We describe three cases of severe erosive diaper dermatitis in pediatric patients aged 2-6 years that were initially concerning for inflicted scald burn or neglect.

Assessment of diaper dermatitis using a novel electronic health record-embedded scale.

OBJECTIVE: Quantify the evolution and severity of neonatal skin injury, specifically diaper skin compromise, by embedding a validated skin integrity evaluation into the electronic health record (EHR). METHODS: Retrospective longitudinal cohort analysis of 747 patients stratified by gestation: 22-27, 28-31, 32-24, and 35-37 weeks, from birth to discharge. Primary outcomes were time to first perineal erythema, duration as percent days with erythema, and severity as maximum score. Data were analyzed using generalized linear models and multiple linear regression methods. RESULTS: Seventy percent had erythema and, of these, 34% had at least one high score with bleeding. Days with erythema ranged from 34-44% (p < 0.05). Days to first erythema were inversely correlated with gestational age. Risks for severe injury included short time to first erythema, 5 or more stools/day, infection, and Caucasian race/ethnicity. CONCLUSIONS: The EHR-based scale can be readily implemented to mitigate diaper skin compromise in premature infants.

Betamethasone cream to treat diapers rash causing Cushing syndrome.

OBJECTIVES: Betamethasone causing iatrogenic Cushing's syndrome (CS) in infants are rarely reported. CASE PRESENTATION: In this case report, there were severe signs of CS, such as considerable weight acceleration and concurrent height deceleration, hirsutism and ecchymosis of the face, and buffalo pad, which are often found in adults. Clobetasol propionate, diflucortolone valerate, and dexamethasone nasal sprays were used in the majority of previously reported cases of corticosteroid abuse, whereas this is the first case of CS in an infant as a result of the use of betamethasone cream, also known as betnesol, which is frequently used by mothers in developing countries as a treatment for rashes. In this instance, a severe medication interaction caused by systemic betamethasone cream buildup led to the creation of CS. For the professionals, these patients are a challenge because of drug use without prescription. CONCLUSIONS: Topical corticosteroid usage puts infants at risk for CS. Because of excessive betamethasone treatment in this child with diaper dermatitis, he acquired CS. It is said to draw attention to the risks of self-medication in developing nations.

[Diaper dermatitis is not always a harmless condition]. / Luierdermatitis is niet altijd onschuldig.

BACKGROUND: Diaper dermatitis in children is common and usually harmless. Often the cause is irritation, a secondary candida infection or eczema, for which treatment is simple and effective. In this paper we show that a therapy resistant diaper dermatitis can be the diagnostic clue to the rare but important diagnosis Langerhans cell histiocytosis (LCH). CASE DESCRIPTION: We saw a 14 months old girl with therapy resistant diaper dermatitis, skin abnormalities on the hairy scalp, fever, otorrhea and extensive lymphadenopathy. After a long period of doctor visits, skin biopsies confirmed the diagnosis of LCH. CONCLUSION: LCH is a rare condition that often manifests in the skin. LCH can manifest in different organs. Although skin involvement is sometimes considered as less relevant, cutaneous manifestations can be an important diagnostic clue. In this paper we show that diaper dermatitis is not always harmless: it can be a symptom of LCH.

Effects of Early Toilet Training and Elimination Communication With Respect to Diaper Types.

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P < .001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P < .001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P < .001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years.

Determination of Selected Harmful Substances in Baby Diapers Available on the South African Market.

Baby diaper rash is a common problem, especially allergic contact dermatitis, which could be due to heavy metals, pH, formaldehyde, or allergens in the diapers. This study reports on the determination of formaldehyde, heavy metals (Pb, As, Co, Cr, Ni, Cu, Zn, Mn, Sr, Fe, and Cd), and pH in diapers purchased from low-, medium-, and high-end stores. Inductively coupled plasma was used to determine the concentrations of heavy metals after extraction using artificial urine and artificial sweat. All heavy metals were found in all diapers except Sr, which was not found in sample M7. All samples had concentrations of heavy metals within the Oeko-Tex limits, except samples H2 and L2, whose Ni concentrations were above permissible limits. Fifty percent of diapers had a formaldehyde concentration above the Oeko-Tex recommended limits. The highest formaldehyde concentration of 17.62 mg/kg was found in diaper M2 and the lowest (ca. 10.4 mg/kg) in H1. All samples had pH values in the alkaline region, with only five samples having pH values within the recommended limits. The research concluded that the diaper rash experienced by some babies, among other factors, could be due to high alkaline skin pH and formaldehyde levels, which are higher than the Oeko-Tex recommended limits.

The development of a nomogram model for the individualized prediction of diaper dermatitis risk in pediatric hospitalized children aged 1-36 months.

AIMS AND OBJECTIVE: To develop a nomogram model for individualized prediction of diaper dermatitis in pediatric hospitalized infants and toddlers aged 1-36 months. BACKGROUND: Diaper dermatitis is a common skin health problem in pediatrics, which brings pain and discomfort to the child. However, there is a scarcity of risk prediction tools for diaper dermatitis in infants and toddlers hospitalized in pediatrics. DESIGN: A cross-sectional study. METHODS: 210 cases each for caregivers and hospitalized children aged 1-36 months were selected as the research objects. A prediction nomogram model was established based on the risk factors according to the results of univariate analysis and multivariate logistic regression analysis. The predictive performance of the nomogram model was evaluated by discrimination and calibration. The clinical utility of the model was evaluated by decision curve analysis. This study was reported using the TRIPOD checklist. RESULTS: 41 hospitalized children with diaper dermatitis with a prevalence of 19.52%. The risk factors included: age in months, diarrhea, history of diaper dermatitis, without prophylactic application of buttock protection products, frequency of diaper change per day ≤6.6 times, and the level of caregivers' knowledge of infantile diaper dermatitis. The results showed that the C-index of the nomogram model was 0.891(95% CI: 0.832, 0.950), the calibration curve manifested a satisfactory consistency, and the net benefit was satisfactory. CONCLUSIONS: The nomogram has a good predictive ability and satisfactory clinical utility, which is useful for pediatric medical staff screening high-risk patients with diaper dermatitis. RELEVANCE TO CLINICAL PRACTICE: The prediction nomogram model can help pediatric medical staff to calculate the risk probability of diaper dermatitis in pediatrics, formulate interventions timely, and optimize pediatric DD standardized care protocols. NO PATIENT OR PUBLIC CONTRIBUTION: the children's caregivers enrolled in this study only for the data collection.

When "the runs" also burns: Case reports of severe diaper dermatitis in children with acute gastroenteritis mimicking scald burns.

Burns to the buttocks of a child are highly concerning for child abuse unless there is a clear history to support an alternative diagnosis. We report two cases of severe erosive diaper dermatitis presenting as buttocks and perineal burns caused by prolonged exposure to diarrheal stool. These cases underscore the importance of making the right diagnosis to avoid the undue psychosocial stress to families that comes with a mistaken diagnosis of inflicted injury, and further add to our understanding of diarrheal contact burns in the absence of laxative use.

Hydrocolloid dressing for the treatment of severe diaper dermatitis.

Diaper dermatitis is a common dermatosis that usually responds to adequate hygiene and topical treatment, but can be a therapeutic challenge. Continuous exposure to feces and urine can cause extensive erosions and pain. The use of hydrocolloid dressings may be helpful in keeping the skin isolated from stool and urine, reducing pain, and enabling skin lesions to heal. We explain an easy technique, utilizing stoma powder and a hydrocolloid dressing, for parents to apply at home.

The measurement of different diaper parameters for the evaluation of postcircumcision bleeding and their significance for the Infant's health.

Background: Evaluation of circumcision bleeding cannot depend on the visual change in the diaper. Diapers have different product features and absorbency capacities. The apparent changes in the diapers may vary according to their absorbent capacity and may not be in parallel with the amount of bleeding. Before significant visual difference occurs, the patient's hemodynamics may be impaired. Aim: Aim of the study is to evaluate better circumcision bleeding. Patients and Methods: Patients were divided into groups according to 12 different brand diapers of the same size, containing super-absorbent material. The study started by 15/01/2022, and finished by end of 01/03/2022. Diapers with concealed brands were soaked with blood with equal hematocrit value in 100 ml with increments of 5 ml. 252 images were obtained by taking 21 images of each diaper with the same method. The diapers were evaluated colorimetrically, and numerical values were obtained showing the color differences in red, green, and blue and saturation and lightness. Working groups were formed according to 12 different brands of diapers of the same size, containing super-absorbent material. Standard statistical tests were performed using obtained values. Result: : Dry diapers had different weights, volumes, and specific gravities; the diapers with the lowest unit weight were ranked ninth in terms of volume; the diapers with the highest specific gravity were ranked third in terms of thinness. There were significant differences in the blood on the diaper, and significant differences between some groups (p < 0.005); on the other hand, there was not any difference between some other groups (p > 0.05). There was a significant relationship in terms of Analysis of Variance (ANOVA) (P < 0.05 and P < 0.01). Visual graphic examination showed that linear but non-parallel color changes occurred. As the blood load increased, the visual and statistical differences between the diapers became more pronounced, and the curves diverged. Conclusion: Visual evaluation of the color change of the diapers may not give accurate results for bleeding follow-up. If necessary to use diapers after circumcision, it is more appropriate to prefer those with low absorbency capacity. Using fabric or cotton products in cases with bleeding risk may be recommended. If bleeding is suspected, hemogram control is the most appropriate option. Diaper manufacturers should warn consumers of the risk. In conclusion, we should be on the safe side for mortality and morbidity.

Perivulvar Pseudoverrucous Papules and Nodules in a 4-Year-Old Girl with Urinary and Fecal Incontinence: Case Report.

BACKGROUND: Diaper (irritative) dermatitis is commonly encountered in pediatric practice. In severe cases, unusual lesions could mimic other vulvar dermatoses or sexually transmitted infections. CASE: A 4-year-old female refugee with urinary and fecal incontinence was referred for medicolegal evaluation (concern for childhood sexual abuse) due to presence of diffuse vulvar, perineal, and perianal lesions. Evaluation and histology were consistent with pseudoverrucous papules and nodules. Resolution occurred following frequent diaper changes and application of a protective ointment. DISCUSSION: Pseudoverrucous papules and nodules are a rare complication of irritative diaper dermatitis with variable appearance. Urinary or fecal incontinence are primary risk factors that should raise suspicion among clinicians when atypical genital or buttocks lesions appear. Biopsy is not always necessary but could be warranted when the diagnosis is uncertain or if childhood sexual abuse is suspected.

The factors related to recovery time of diaper dermatitis in infants: A prospective observational study.

AIM: Prolonged diaper dermatitis may increase the risk of atopic dermatitis or infections. This prospective observational study aimed to investigate the prevalence, symptoms, areas, and recovery time of diaper dermatitis in infants aged 1 month and identify the factors related to recovery time. METHODS: Diaper dermatitis was defined as the presence of erythema, papules, dryness, erosion, or ulceration in the diapered area. Recovery time was days between infant's 1-month medical check-up and disappearance of symptoms. Survival analysis was performed using the Kaplan-Meier method, and the log-rank test was used to identify the factors related to recovery time. RESULTS: Among 113 infants, 66 (58.4%) had diaper dermatitis, with erythema at the perianal area being the most common symptom. The median recovery time was 10 days. Four infants (6.1%) had diaper dermatitis for >5 weeks. Severity was not related to recovery time. CONCLUSIONS: A frequency of diaper changing of ≤10 times per day was a risk factor for recovery time. Our data showed recovery in approximately 10 days, regardless of severity at study enrollment. Health care professionals could inform parents of recovery time and recommended diaper changing frequency.