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.

[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.

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.

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.

Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review.

RATIONALE: Diaper dermatitis (DD) is a significant problem in the care of newborns, infants, and young children and good recognition of signs and symptoms optimises timely treatment. There is also a need for a standardised set of related descriptors to enable communication between health care providers about diagnosis and treatment. OBJECTIVE: The study aimed to review the literature for descriptive words to define the clinical signs, symptoms, and characteristics, including anatomical locations and assessment scales or tools, in the newborn, infants and young children population who have been diagnosed with DD. METHODS: A systematic review process utilising PRISMA guidelines [1] was conducted using advanced search techniques to analyse the terms from the database thesauri and keywords. Data bases including Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations, Daily and Versions® were searched from 1946 to March 18, 2021. Cochrane Handbook Searching for and selecting studies were used as a guide and as best practice to conduct the search. RESULTS: Of the 551 publications originally identified, 55 full text publications were examined and 21 met the inclusion criteria. The wide range of descriptors used in the literature for DD supports the need for a clearer approach to report the signs and symptoms, and the severity, of DD. CONCLUSIONS: These findings point to gaps in the literature, both in recording signs and symptoms of DD and features such as wetness, infection, anatomical location, severity and pain in newborns, infants, and young children. There is a need to develop a robust methodological tool to bridge the gap and link a common terminology on signs and symptoms to support diagnosis of the severity of DD.

The Importance of Skincare for Neonates and Infants: An Algorithm.

BACKGROUND: The skin of neonates and infants undergoes a maturation process from birth and is susceptible to barrier disruption. The current algorithm follows a US-based consensus paper on skincare approaches using gentle cleansers and moisturizers in neonatal and healthy infant skin. This summary provides clinical information for pediatric dermatologists, dermatologists, and pediatric healthcare providers treating neonates and infants. METHODS: The project used a modified Delphi process comprising virtual discussions followed by an online follow-up replacing the use of a questionnaire. During the virtual meeting, the systematic literature review results and a draft algorithm addressing over-the-counter skincare for neonates and infants with healthy skin were discussed and adopted using evidence coupled with the expert opinion and experience of the panel. RESULTS: The algorithm addresses three clinical signs: xerosis, erythema, and erosion/bulla. A growing body of evidence recognizes the benefits of ongoing daily use of non-alkaline cleansers and ceramides containing moisturizers to reduce inflammation and maintain a healthy skin barrier function. Diaper rash is common in infants presenting as erythema or, in more severe cases, skin erosion. Skin protection with a barrier cream and frequent diaper changes using disposable diapers resolves most cases; however, if the rash continuous despite appropriate care, rule out a candida infection. CONCLUSION: The current algorithm focuses on neonatal and infant healthy skin that can benefit from skincare. When applied from birth onwards, gentle cleansers and moisturizers containing barrier lipids help maintain the protective skin barrier. J Drugs Dermatol. 2021;20(11):1195-1205. doi:10.36849/JDD.6219.

[Sevestre-Jacquet posterosive syphilitic dermatitis associated with the use of reusable diapers: A clinical case]. / Dermatitis sifiloide posterosiva de Sevestre-Jacquet asociada al uso de pañales reutilizables: caso clínico.

BACKGROUND: Diaper dermatitis is a skin problem that has decreased with the development of new technologies in disposable diapers that prevent excessive moisture in the perianal region. The following clinical case shows the relationship between the use of cloth reusable diapers and the appearance of Jacquet erosive diaper dermatitis, a serious and rare complication of diaper dermatitis. CLINICAL CASE: We present the case of a 1-year-11-month-old patient, taken to the Dermatology department due to the presence of a lesion in the gluteal region. The mother reported the onset of the condition four months ago after the presence of semi-liquid stools. Localized dermatosis is observed on both lower limbs, affecting the genital region in the labia majora and the perianal region at the level of the intergluteal folds bilaterally and symmetrically. In the histopathological study, a posterosive Sevestre-Jacquet syphilid was diagnosed. CONCLUSION: Sevestre-Jacquet's posterosive syphilitic dermatitis is a rare dermatological condition and its risk of occurrence is greater due to the use of ecological cloth diapers.

INTRODUCCIÓN: la dermatitis de pañal es un problema cutáneo que ha disminuido con el desarrollo de nuevas tecnologías en los pañales desechables, los cuales impiden la humedad excesiva en la región perianal. En el siguiente caso clínico se muestra la relación entre el uso de pañales de tela y la aparición de dermatitis sifiloide posterosiva de Sevestre-Jaquet, una complicación grave y poco frecuente de la dermatitis de pañal. CASO CLÍNICO: presentamos el caso de una paciente de 1 año y 11 meses de edad, llevada a la consulta externa de Dermatología por la presencia de una lesión en la región glútea. La madre refirió inicio del padecimiento cuatro meses atrás y posterior a la presencia de evacuaciones semilíquidas. Se observa dermatosis localizada en ambos miembros inferiores, que afecta la región genital en labios mayores y región perianal a nivel de pliegues interglúteos de forma bilateral y simétrica. En el estudio histopatológico se emite el reporte diagnóstico de sifiloide posterosivo de Sevestre-Jacquet. CONCLUSIÓN: la dermatitis sifiloide posterosiva de Sevestre-Jacquet es una condición dermatológica poco frecuente y su riesgo de ocurrencia es mayor debido al uso de pañales ecológicos de tela.

Adaptación transcultural y validación psicométrica en lengua española de la escala Perineal Assessment Tool para la evaluación de la dermatitis por incontinencia / Cross-cultural adaptation and psychometric validation in Spanish language of the Perineal Assessment Tool for Incontinence associated dermatitis assessment

INTRODUCCIÓN: La dermatitis asociada a la incontinencia es un importante problema de salud que puede comprometer la salud de quienes la sufren y representa importantes costes para el Sistema de Salud. La Perineal Assessment Tool es el único instrumento diseñado específicamente para evaluar el riesgo de la dermatitis asociada a la incontinencia. OBJETIVOS: realizar la adaptación transcultural y el análisis de las propiedades psicométricas de la versión española de la Perineal Assessment Tool. MÉTODO: Se utilizó un diseño de estudio observacional dividido en tres fases. En la primera fase se llevó a cabo un proceso de traducción y adaptación transcultural de la escala. En la segunda fase, se realizó una prueba piloto (n = 15) utilizando un diseño transversal para determinar la viabilidad, la fiabilidad intraobservador e interobservador, y la validez de contenido de la versión española de la escala. Finalmente, en la tercera fase se realizó un estudio transversal utilizando una muestra de 171 pacientes para determinar la prevalencia de dermatitis asociada a la incontinencia y analizar la consistencia interna, la validez de criterio y constructo, la sensibilidad, la especificidad, el valor predictivo positivo y negativo, así como los puntos de corte de la escala. RESULTADOS: En la primera fase, la versión española de la escala Perineal Assessment Tool demostró ser viable, administrable en menos de 3 minutos, fácil de comprender y completar. En la segunda fase, el índice de validez del contenido global de la versión española de la escala Perineal Assessment Tool fue de 0,83; la fiabilidad intraobservador, de 0,98, y la fiabilidad interobservador, de 0,99. En la tercera fase, la versión española de la escala Perineal Assessment Tool mostró una consistencia interna de 0,601 y una correlación significativa con los apartados de humedad de las escalas de valoración de riesgo de úlceras por presión Braden y EMINA. La curva de ROC fue de 0,959 y los mejores valores fueron los presentados en una puntuación de 7, mostrando un valor predictivo positivo del 96,7%, un valor predictivo negativo del 0,6%, una sensibilidad del 74,4%, una especificidad del 99,2% y, finalmente, una validez global del 93,6%. CONCLUSIONES: La versión española de la Perineal Assessment Tool ha demostrado ser un instrumento válido y fiable para la evaluación de la dermatitis asociada a la incontinencia en pacientes institucionalizados en el contexto español

INTRODUCTION: Incontinence associated dermatitis is a major health problem that can compromise the health of sufferers and represents significant costs to the Health System. The Perineal Assessment Tool is the only instrument specifically designed to assess the risk of incontinence dermatitis. PURPOSE: It was the cross-cultural adaptation and analysis of the psychometric properties of the Spanish version of the Perineal Assessment Tool scale. METHODS: An observational study design divided into three phases was used. In the first phase, a process of translation and cross-cultural adaptation of the scale was carried out. In the second phase, a pilot test (n=15) was carried out using a cross-sectional design to determine viability, intraobserver and interobserver reliability, and content validity of the Spanish version of the scale. Finally, in the third phase, a crosssectional study was performed using a sample of 171 patients to determine the prevalence of incontinence-associated dermatitis and to analyze the internal consistency, criterion and construct validity, sensitivity, specificity, positive and negative predictive value, as well as the cut-off points of the scale. RESULTS: In the first phase, the Spanish version of the Perineal Assessment Tool proved to be feasible, manageable in less than 3 minutes, easy to understand and complete. In the second phase, the validity index of the overall content of the Spanish version of the Perineal Assessment Tool scale was 0.83, the intra-observer reliability was 0.98 and the inter-observer reliability was 0.99. In the third phase, the Spanish version of the Perineal Assessment Tool scale showed an internal consistency of 0.601 and a significant correlation with the humidity sections of the Braden and EMINA pressure ulcer risk assessment scales. The ROC curve was 0.959 and the best values were presented in a score of 7, showing a positive predictive value of 96.7%, a negative predictive value of %, a sensitivity of 74.4%, a specificity of 99.2% and, finally, an overall validity of 93.6%. CONCLUSIONS: The Spanish version of the Perineal Assessment Tool has proved to be a valid and reliable instrument for the evaluation of incontinence associated dermatitis in institutionalised patients in the Spanish context

Diaper rashes can indicate systemic conditions other than diaper dermatitis.

BACKGROUND: Although the majority of rashes in the diaper area are caused by irritation from urine and feces, irritant diaper dermatitis; IDD, there are some less common but potentially serious cutaneous eruptions associated with systemic diseases that should not be discounted. METHODS: This prospective descriptive study aimed to explore variation in cutaneous disease in the diaper area. It was conducted as a prospective descriptive study between October 2016 and November 2019 in the pediatric department of a tertiary-level hospital. RESULTS: Three hundred consecutive patients with rashes in the diaper area were enrolled. The most common diagnosed was IDD (125 cases; 41.7%), followed by rashes exacerbated by the diaper (101 cases; 33.67%) and non-diaper-related rashes (74 cases; 24.67%). CONCLUSIONS: Our finding suggests that when diagnosing rashes that occur in the diaper area, general pediatricians should consider, in addition to IDD, the possibility of less-common conditions. The simultaneous presence of cutaneous lesions at other sites was linked to diagnoses of systemic diseases other than IDD, (P < 0.001).

Prospective trial for the clinical efficacy of anogenital skin care with miconazole nitrate-containing soap for diaper candidiasis.

Anogenital skin care for the elderly remains an umbrella term concerning protective and non-interventional regimens, particularly for ordinary diaper users. Our recent investigation has demonstrated the preventive effect of daily anogenital washing with miconazole nitrate-containing soap to the development of diaper candidiasis. We extended this work to cover our hypothesis as to whether the miconazole soap has a therapeutic benefit in genital candidiasis. The study outline includes: (i) the enrollment of 21 bedridden inpatients (84 ± 9 years; eight men and 13 women) who were diagnosed clinically and mycologically with genital candidiasis, and who had never received topical and/or systemic antifungal agents; (ii) administration of anogenital washing with 0.75% miconazole-containing soap once daily for 4 weeks; and (iii) assessment of clinical symptoms and detection of Candida materials by culture and microscopic examination. As assessed by clinical symptom scoring for incontinence-associated dermatitis (IAD), the ratio of patients with severe to moderate symptoms dramatically decreased by 2 weeks and 10 of 21 patients became symptom-free at 4 weeks. The IAD clinical severity score was significantly decreased at 4 weeks. Compared with the baseline positivity, both microscopic and cultured Candida-positive rates were significantly decreased at 4 weeks after washing. All culture-detected fungi were Candida albicans. Severe adverse events did not occur in all participants. Individual medical and risk factors had no significant correlation with clinical severity and duration of candidiasis on variance analysis. In conclusion, topical washing with miconazole soap is a safe and reliable non-medical approach for soothing diaper-associated genital candidiasis in bedridden inpatients in whom it is difficult to perform prompt medical examination.

Dermatitis perianal y test de diagnóstico rápido / Perianal dermatitis and rapid diagnostic test

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Use of Potassium Hydroxide (KOH) Test Reduces Antifungal Medication Prescription for Suspected Monilial Diaper Dermatitis in the Neonatal Intensive Care Unit: A Quality Improvement Project.

BACKGROUND: Despite availability of rapid fungal potassium hydroxide (KOH) tests, many care providers rely on visual assessment to determine the diagnosis of monilial diaper dermatitis (MDD). PURPOSE: To determine whether a KOH test, when MDD is suspected, would result in more accurate diagnoses, with decreased antifungal medication prescription and exposure. METHODS: Quality improvement project from 2016 through 2017 with protocol implemented in 2017 for treatment of MDD after positive KOH testing. If monilial rash suspected, after 2 negative KOH tests, then antifungal ordered (considered false negative). χ testing and cost determination were performed. SAMPLE: Neonates in 2 level III neonatal intensive care units. OUTCOME VARIABLES: KOH test results, use of antifungal medication, and cost. RESULTS: The patient census included 1051 and 1015 patients in the year before and after the protocol initiation. The medical orders for antifungal medication decreased from 143 to 36 (P < .001; 95% odds ratio confidence interval, 2.24-4.38). There was a 75% reduction in both use and cost, as charged, of antifungal agents. Overall charges, including KOH test costs, decreased by 12%. Three infants received multiple negative KOH tests, then a positive one. These met the definition of false-negative tests, per protocol. There were no cases of fungal sepsis. IMPLICATIONS FOR PRACTICE: Use of a quality improvement protocol, in which the use of KOH testing is required, before antifungal agents are prescribed, results in decreased exposure and costs. IMPLICATIONS FOR RESEARCH: To test the feasibility of bedside "point-of-care" KOH testing, and whether KOH testing and reduced antifungal medication use affects antimicrobial resistance or invasive fungal sepsis.

Lesiones ulcerosas en sacabocados en la región del pañal / Ulcerous damage in punched out lesions around the diaper area

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