Treatment of diaper dermatitis in newborns. How diaper dermatitis manifests itself, adequate therapy and prevention of the disease in a child. How to treat diaper dermatitis not complicated by microbial infection

One of the fairly common problems of children in the first year of life is diaper dermatitis. This is the name of the complex of inflammatory changes in the surface layers of the skin of an infant, due to the influence of adverse and irritating external factors. Diaper dermatitis usually captures the perineum, buttocks, and inguinal folds in a child. Inflammation can also spread to the upper thighs and lumbosacral region.

According to medical statistics, the disease in the first year of life is diagnosed in 35-50% of children. In adults, conditions similar in symptoms to infant diaper dermatitis are also possible. They are usually caused by insufficient hygienic care of the skin of bedridden patients who are not able to serve themselves and do not sufficiently control the functioning of the pelvic organs. In most cases, this is diagnosed.

Why develops

Until the 70s of the XX century, the leading pathogenetic theory of the occurrence of diaper dermatitis was the so-called "ammonia concept". Symptoms were thought to be due to long-term exposure to ammonia in the urine. It was this substance that was recognized as the most aggressive for infant skin. And since the characteristic inflammation occurred only in children who had been in diapers contaminated with urine for a long time, dermatitis was called diaper dermatitis. This term is widely used in modern pediatrics.

Currently, views on the causes of diaper dermatitis have been revised. The disease is recognized as polyetiological, while both external and some internal factors have pathogenetic significance. These include:

• Mechanical damage to the epidermis with a diaper, diaper or any tissue that is directly adjacent to the baby's skin.
• Swelling and maceration of the keratin layer of the dermis in conditions of high humidity. This is facilitated by an untimely change of a diaper / diaper / underwear and the use of absorbent devices with a waterproof layer (oilcloth).
• Softening and damage to the epidermis due to exposure to various aggressive substances from the urine and feces of an infant. The most important are urea and its cleavage products, bile acids, residual amounts of digestive enzymes secreted by the intestinal microflora of the compound. An important pathogenetic point is the breakdown of urea to ammonia under the action of bacterial urease. In some cases, altered stool acidity becomes a key factor.
• Age-related features of the skin of infants, which determine its insufficient barrier function in comparison with the dermis of an adult. The epidermis of the baby is thin, saturated with moisture, with a poorly developed keratin layer. The skin is quite loose due to the reduced amount of connective tissue, while it is abundantly supplied with blood and easily swells. All these features contribute to the easy appearance of microdamages with the subsequent development of inflammation.
• microbial factor. In this case, it is not pathogenic bacteria that are important, but opportunistic microorganisms of the colonic and skin microflora.

In one child, several causes of skin lesions can be traced simultaneously. At the same time, diaper dermatitis does not develop in all children in similar conditions. How is the disease formed and what predisposes to it?

Issues of pathogenesis

Contributing factors include diarrhea, immunodeficiencies of various origins, dysbiosis (including those associated with antibiotic therapy), allergic reactions, and polyhypovitaminosis. Of great importance are the systematic errors in daily hygienic care, the irrational use of emulsions, rare bathing, the short duration of air baths, and the rejection of washing in favor of wiping. Children with atopy, "lymphatic" constitution, immaturity of the digestive system at the time of introduction of complementary foods are also predisposed to diaper dermatitis.

Despite the widespread use of disposable products and ongoing education about infant hygiene, exposure to wet diapers (or soiled diapers) remains a major precipitating factor in diaper dermatitis.

Increased skin moisture increases the friction of its surface with adjacent tissue. And the concomitant swelling of the epidermis significantly increases the likelihood of multiple microdamages. In a humid environment, the permeability of the skin barrier also changes, the susceptibility of tissues to the action of digestive and bacterial enzymes, weak acids and alkalis increases. And the breakdown products of urea lead to a change in pH on the surface of the skin, which exacerbates the situation.

The loosened and edematous epidermis can no longer prevent the colonization of various microorganisms and the penetration of various substances. It causes inflammation, which quickly captures the underlying layers of the skin. However, it is rarely aseptic. In conditions of high humidity and altered acidity, conditionally pathogenic microorganisms are activated, which is why fungal diaper dermatitis is often diagnosed. It is also possible to attach a secondary bacterial infection - staphylococcal or streptococcal.

Clinical picture

The main symptoms of diaper dermatitis:

• Redness (hyperemia) and soreness of the skin in the perineum, on the buttocks, inguinal folds, around the anus and genitals. Sometimes it captures the hips and even the sacro-lumbar region.
• The absence of clearly defined boundaries between the affected area and healthy skin. Around the lesion there is an area of ​​dim, uneven and gradually fading hyperemia of a small size. At the same time, the area of ​​redness is limited to the diaper.
• Irregular hyperemia. Often in the depths of natural skin folds there are zones of enlightenment with slightly pronounced signs of inflammation. Increased hyperemia is noted in places where urine flows, around the diaper elastic bands. In the presence of liquefied, sour, or overly fermented stools, the most pronounced redness appears around the anus.
• Slight swelling of the inflamed skin, due to which the focus of inflammation becomes more dense to the touch and may rise slightly. In a severe form of the disease, infiltration of the entire dermis and even underlying tissues appears.
• Areas of inflammation are asymmetrical, irregularly shaped, prone to fusion with the progression of the disease.
• Dryness, roughness of the affected skin, which is associated with the presence of a small papular rash. It is also possible the appearance of small-lamellar uneven peeling, usually at the site of fading areas of inflammation.
• The appearance of a vesicular rash is not excluded - from single elements to confluent eroded areas. The opening of the vesicles leads to the formation of weeping painful surfaces, which, as they heal, become covered with thin serous crusts.

Candidiasis diaper dermatitis is accompanied by the appearance of bright painful hyperemic areas with multiple confluent erosions. And the addition of a bacterial infection leads to the formation of pustules, increased swelling and redness of the skin.

Associated symptoms

Diaper dermatitis in children is not accompanied by fever and intoxication. However, when the symptoms of this disease appear, the child becomes moody and restless, which is associated with physical discomfort and even pain. He may have trouble sleeping.

Unpleasant sensations are aggravated after urination and defecation, if the discharge falls on areas of inflamed skin. Therefore, when a child with diaper dermatitis is in a diaper or diaper, parents may note a relationship between the time of onset of crying and bowel or bladder emptying. With a widespread inflammatory process, even movements of the legs in the hip joints can cause anxiety in an infant. After all, they are accompanied by skin friction in the inguinal and gluteal folds, which are often affected by inflammation.

candida diaper dermatitis

What is diaper dermatitis

Diaper dermatitis is classified according to severity. At the same time, the severity and prevalence of the main symptoms, the presence of signs of infectious complications are taken into account.

• Mild dermatitis. It is characterized by mild, mild hyperemia without obvious swelling and infiltration, and foci of a small papulo-macular rash may appear. The focus of inflammation occupies a small area and does not significantly affect the well-being and behavior of the child.
• Dermatitis of moderate severity. Hyperemia is quite bright, extensive, accompanied by local swelling or even the appearance of individual foci of infiltration. The rash is predominantly small papular, abundant. Perhaps the appearance of individual erosions at the site of single opening vesicles with serous contents. The symptoms present have a significant impact on the well-being of the child.
• Severe diaper dermatitis. The zone of pronounced hyperemia captures almost the entire area of ​​the skin under the diaper, often going into the crease between the pubis and abdomen, thighs, and sacrum. This is accompanied by severe edema, sufficiently deep infiltration, the appearance of multiple deep weeping erosions and ulcerations. The rash is profuse, vesiculo-papular and pustular. The severe course of diaper dermatitis is a consequence of infection and the development of complications.

Stages of diaper dermatitis

Diaper dermatitis in most cases is mild or moderate in severity. However, this disease can occur with various complications, which are mainly associated with secondary infection of tissues. These include the development of gluteal granuloma, abscesses, phlegmon, sepsis. Girls often have vulvovaginitis.

Staphylococcal diaper dermatitis

Diagnostics

Diagnosis of diaper dermatitis is not difficult. The characteristic localization of the appearance of the focus of inflammation, infancy, and the identification of predisposing and provoking factors practically exclude a diagnostic error. An indication of parents (or caregivers) that a child has a rash, diaper rash, “irritation” of the skin on the buttocks and in the perineum requires a thorough examination of the baby. In this case, the main task of the doctor is to conduct a differential diagnosis and clarify the nature of background and provoking conditions.

Diaper dermatitis should be distinguished from other types of dermatitis: allergic, contact,. It is important to understand that their presence is not an exclusive factor. All these forms of skin lesions can contribute to the development of diaper dermatitis, acting as a background and aggravating process. In this case, the doctor will need to make appropriate adjustments to the basic treatment regimen.

Diaper dermatitis is not characterized by the appearance of redness and rash on other parts of the body. If foci of inflammation are detected on the face, flexion surfaces of the arms and legs, atopy and a general allergic reaction should be excluded. Localization of redness mainly in the anus requires examination of the child for intestinal infections, diarrheal syndrome, enzyme deficiency. And the presence of a well-defined diffuse hyperemia and the relationship between its appearance and a change in diaper brand are the basis for excluding contact dermatitis.

If signs of infection are detected, it may be necessary to conduct a bacteriological examination of scrapings from inflamed skin areas. This is necessary to clarify the type and sensitivity of the pathogen.

Treatment

How to treat diaper dermatitis in a newborn, the doctor determines. At the same time, it is important not only to use certain drugs, but also to adjust the care provided to the child. Therefore, the most important task of the pediatrician is to teach parents or other caregivers the skills of daily hygiene of the baby.

Treatment of diaper dermatitis is mainly local. The main groups of prescribed drugs:

• Means of local action that promote the regeneration and epithelialization of affected tissues and have a mild non-specific anti-inflammatory effect. Most often, ointment and cream for children based on dexpanthenol (Bepanten, D-Panthenol) are used for this purpose. By agreement with the doctor, sea buckthorn oil can be used.
• Means with anti-inflammatory and drying effect. In mild cases, zinc-based powder is sufficient, but zinc ointment, Tsindol and Desitin are most often prescribed. Fukortsin is used to extinguish erosion.
• With the fungal nature of diaper dermatitis, antimycotic (antifungal) agents are indicated. For this purpose, nystatin ointment, Clotrimazole, Diflucan are used.
• Bacterial infection is the basis for the use of agents with local antimicrobial action - for example, Baneocin, ointments with erythromycin, tetracycline and other antibiotics.
• Local glucocorticosteroids. The doctor makes a decision on their use if diaper dermatitis does not go away within 5-7 days of adequate therapy. The drug of choice is Advantan. But a hormonal ointment, cream or emulsion cannot be used for a fungal infection.
• Antibacterial agents of systemic action - with the development of purulent complications.
• Antiallergic drugs in the treatment of diaper dermatitis are not indicated. An exception are cases when allergic or contact dermatitis acts as a provoking factor.

As an aid, in agreement with the doctor, traditional medicine can be used: decoctions and infusions of plants with anti-inflammatory, antimicrobial effects.

Forecast

Parents and caregivers are usually most interested in how long diaper dermatitis lasts. The duration and prognosis of the disease depend on a number of factors: the underlying cause, the presence of background and predisposing conditions, the severity of the symptoms present. Of great importance are the timeliness and usefulness of treatment, adequate correction of hygienic care for the child.

Uncomplicated easily flowing diaper dermatitis, subject to the doctor's recommendations, disappears without a trace within 3-4 days. The absence of unremovable predisposing factors (eg, lymphatic-hyperplastic constitution and insufficiency of cellular immunity) is a favorable sign. In these children, with proper care, symptoms usually do not recur.

Rapidly progressing and complicated cases of dermatitis are the basis for classifying a child as a risk group for the development of a recurrent form of the disease. Unfavorable factors also include the presence of atopy in the baby, immunodeficiency, pathology of the digestive system, and social disadvantage of parents.

Diaper dermatitis does not contribute to the development of other dermatological diseases and is not prone to transformation. The risk of its re-development is minimized when the child develops hygiene skills and refuses diapers.

Prevention

Adequate perineal skin care, regular washing and bathing of babies, daily repeated air baths, timely treatment of intestinal disorders and relief of allergic reactions - all this has a preventive effect. It is also important not to wrap the baby up, to choose the correct diaper size and to correctly combine the daily care products used with each other.

Diaper dermatitis in most cases is curable, its symptoms disappear within a fairly short time. Early contact with a doctor and compliance with his recommendations will prevent a severe and complicated course of the disease.

Many mothers face a certain standard set of problems with their newborn babies. One of them is diaper dermatitis. It is very important to notice the beginning of its development in time, which will help to effectively eliminate the process, preventing the spread and aggravation of the condition of the inflamed skin of the child.

is an inflammatory reaction of the skin of an infant as a result of exposure to mechanical, physical, chemical and microbial factors. At the same time, they all join each other in a clear sequence. It occurs more often in girls and children who are formula-fed. Although, in total, it is tolerated by about 60-62% of newborns. It can last from birth throughout the entire breast period (up to 3 years of age), until the child has the opportunity to control his discharge. Typically, the peak incidence occurs between 6 and 12 months. Very important is the nature of the child's nutrition and the predisposing properties of the skin. In most cases, this is associated with a persistent course and frequent relapses. There was a direct connection with the presence of dermatitis of another localization and manifestations of diathesis (, gneiss, atopic dermatitis).

Diaper dermatitis occurs due to increased moisture in the area of ​​\u200b\u200bfitting diapers or diapers to the skin, especially if air access to them is limited. Against this background, sensitive children's skin is even more at risk. Any irritating agent, which can be feces or urine, is enough for an inflammatory response of the skin to occur. If minimal tissue friction is added to everything, then the disease acquires a detailed clinical picture with vivid manifestations. As the skin matures and acquires protective mechanisms, the problem goes away by itself.

What does diaper dermatitis look like?

Usually, diaper dermatitis begins to develop as abrasions and redness of the skin in the area of ​​​​the inguinal folds, genitals, buttocks and thighs. Most often, this is called diaper rash. But it is the first stage in the development of the disease, and if appropriate measures are not taken, the process will begin its further progression with the gradual addition of other mechanisms for the development of inflammation, like a vicious circle. All these components support each other, as a result of which dermatitis spreads to healthy areas of the skin. At the same time, it appears:

Red spots of different sizes and shapes, which merge with each other, occupy large areas;

Small papules (intradermal vesicles) on the background of reddened skin;

Peeling and crusts;

Small wounds and erosion;

Vesicles filled with cloudy contents. It is characteristic of advanced diaper dermatitis, due to its infection with staphylococcus aureus or a fungal infection.

Among the varieties of the process, separate subspecies are distinguished when it is local in nature, limited only to certain small zones.

In the area of ​​​​the folds of the neck with constant regurgitation, when the gastric contents enter them, causing inflammation under diapers or clothes;

Perianal dermatitis is inflammation of the skin around the anus. This is more often associated with the peculiarities of the child's nutrition and the enzymatic activity of feces;

Limited damage to the inguinal folds;

Isolated dermatitis of the genital organs. Associated with the characteristics of the urine of the child.

A routine examination is sufficient to make a correct diagnosis. Additional diagnostic procedures are not needed. They may be needed only in the case of a persistent flow of the process. In such cases, a smear is made from the affected skin for the composition of the microflora.

In fact, diaper dermatitis is the result of poor care. But not always it can depend only on the correctness of the actions of the mother. Naturally, today there is no need to look at the baby's ass after each urination. The diaper will do it for mom. But some components of this "miracle of technology" can cause irritation in a particular baby, due to the individual skin reaction. In addition, if care items are hard, they can cause mechanical damage to the skin or abrasions. If you do not pay attention to this in time, then the infection living on the surface of the skin will do it much faster. Its accession will cause even more aggravation of the situation.

Diaper dermatitis thus, it is worth considering a separate rubric among the causes of this disease. On the one hand, some children without these remedies show signs of dermatitis. On the other hand, in some babies, even a single use of a diaper significantly reduces its manifestations. Therefore, it is necessary to correctly approach the choice of this tool not according to advertising or the advice of friends, but according to the individual reaction of a particular baby to all innovations.

As for the action of chemical factors, these include the feces and urine of the baby. They are very aggressive towards delicate skin, which is not yet capable of autoregulating the processes of cleansing and protection. If their action continues systematically, this will inevitably lead to the development of diaper dermatitis. At the same time, physical factors are activated in the form of steaming and hypothermia of the skin.

All of the above, regardless of the root cause, will lead to the attachment of absolutely all components of the mechanism for the development of diaper dermatitis, which must be taken into account for a really quick and effective elimination of the disease.

How to treat diaper dermatitis?

For the correct and competent elimination of a painful problem, both for the baby and for the mother, it is worth following the recommendations.

Maintaining areas of the skin exposed to this inflammatory process in a dry and clean condition. This can be achieved by using diapers with a gel impregnation of the inner moisture-permeable layer. It is necessary to monitor the conformity of the size of the diaper and the child, the correct dressing. Nothing should prevent the baby from moving, there should not be folds and accumulations of tissues in one place.

Prompt diaper change. Equally important, especially if the process has already begun. During this, it is necessary to wipe the skin with an ordinary gauze cloth moistened with a warm solution of chamomile, string or oak bark. After that, let the child lie down in such a naked form. Access to fresh air will saturate the skin with oxygen.

Treatment of the skin before putting on the diaper. For these purposes, you can use complex powders containing zinc oxide, talc, minerals and trace elements, ordinary zinc ointment, creams desitin, drapolen, bepanten, D-panthenol, sudocrem.

If there are signs of a fungal infection, appropriate ointments are prescribed - clotrimazole, miconazole.

Bacterial suppuration is an indication for the use of antibacterial ointments. It is best to use tetracycline eye ointment, as it does not cause a burning sensation in a child.

Proper dressing of the child. Clothing should be spacious enough, but not too big. Do not wrap the baby tightly, as this can lead to overheating and an increase in the humidity of skin areas subjected to constant friction.

The best way to prevent diaper dermatitis, as well as other diseases, is love and attention to your baby.

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. He also received a certificate of a specialist in 2014.

Babies in their first year of life often develop inflammatory skin lesions. The most common phenomenon is diaper dermatitis, which is characterized by redness and irritation of the skin in the groin area, and in advanced cases may be accompanied by the appearance of rashes, pustules, weeping wounds and peeling.

The development of inflammation is facilitated by the peculiarities of delicate children's skin, which is sensitive to the negative effects of external factors: mechanical (wet diapers or diapers), physical (high humidity and temperature), chemical (exposure to ammonia, digestive enzymes). The attachment of microbial agents to inflamed skin can cause complications of dermatitis and have a toxic effect on the sensitive skin of a child.

Diaper dermatitis in children of the first years of life is a widespread phenomenon, if unfavorable symptoms appear, you should consult a pediatrician or an allergist. The specialist will help you choose the necessary drugs and tell you how to treat diaper dermatitis.

Symptoms of diaper dermatitis can appear from the first weeks of a baby's life, and the peak of the disease falls on the period from 7 to 12 months, when food becomes more varied and complementary foods are added to the child's menu. The main factors provoking the development of dermatitis are:

• Increased humidity and temperature under diapers or in a diaper
• Difficulty in getting air to the skin
• Friction on diapers and clothes
• Presence of chemical irritants in urine and feces (ammonia, bile salts)
• Infection of the skin with pathogenic microflora or fungi

A favorable background for the occurrence of dermatitis is created due to the immaturity of the skin of infants, the imperfection of its thermoregulatory and immune functions. The development of diaper dermatitis is promoted by congenital allergic diseases (atopic or seborrheic dermatitis), in addition, an irritation reaction may appear in response to improper feeding and early introduction of complementary foods.

In some cases, the symptoms of dermatitis arise from the use of hygiene products or new diapers of the wrong size that rub the skin.

Provoke the development of irritation can be insufficient hygiene care and a long stay of the baby in dirty diapers. When urine comes into contact with faeces, ammonia interacts with uric acid and food enzymes, which increases the irritant effect on the skin.
In some cases, the child has an increased predisposition to the development of diaper dermatitis, which is associated with the reaction of the skin to irritants and a tendency to allergies. Such a reaction is observed in children with impaired water-salt metabolism, increased ammonia in the urine and intestinal disorders (dysbacteriosis).

Violation of the barrier function of the skin is often accompanied by the addition of a secondary infection caused by streptococci or fungi of the genus Candida. In such cases, they speak of candidal dermatitis. Often, candidal diaper dermatitis develops as a result of treating a child with broad-spectrum antibiotics.

These drugs kill bacteria but are powerless against the yeast Candida, which is present in the intestines and stools of most children. As a result, the growth of fungi increases, and the infection attacks the skin.

Thus, the main factors provoking the disease are the physiological characteristics of the skin of babies, and the violation of hygienic rules of care.

Symptoms

The main symptoms of diaper dermatitis are redness and irritation of the skin in the groin, thighs and buttocks of the child. In places of direct contact with the diaper, bubble rashes, areas of peeling and weeping may appear. In advanced cases, ulcerations, pustules form on the inflamed skin, swelling is observed. Irritation and redness in the anus often occurs in formula-fed babies and is caused by alkaline stools.

Redness and inflammation of the skin is noted in places subjected to mechanical friction in contact with diapers or clothing. Persistent diaper rash in the skin folds and on the buttocks may appear in children with seborrheic dermatitis. The course of diaper dermatitis is characterized by an undulating character, exacerbation of symptoms can be caused by any provoking factor, high humidity, food allergens, and insufficient hygiene.

Candidal diaper dermatitis in children manifests itself by the appearance of pink papules and erythematous plaques, with their spread to the groin, genitals and buttocks. Foci of dermatitis are red spots with uneven edges, the appearance of weeping, painful areas and the spread of pustules are noted. The child becomes restless, capricious, often cries. If the symptoms of diaper dermatitis persist on the skin for more than 72 hours and traditional treatment does not work, a fungal infection of the skin is suspected.

Depending on the symptoms, it is customary to subdivide diaper dermatitis into three degrees:

1. Light. There is a moderate reddening of the skin, the appearance of a rash, peeling and irritation of the inflamed areas.
2. Average. The inflamed skin is covered with papules, erosions, an infiltrate forms in the deep folds of the skin, and the risk of a secondary infection increases.
3. Heavy. There are abundant rashes, vesicles filled with serous fluid. Extensive infiltrates, deep erosions, weeping areas are formed. Dermatitis spreads, capturing and affecting large areas of the skin.

In some cases, diaper dermatitis can indicate the development of serious diseases. The child must be urgently shown to the doctor if his temperature rises sharply, abscesses appear on the inflamed skin, severe swelling, and the skin becomes purple-cyanotic. Medical assistance is also necessary in cases where the treatment of dermatitis at home for 5-7 days does not give a positive result.

The basis of the treatment of diaper dermatitis is careful hygiene and proper care. Most manifestations of dermatitis disappear with simple measures such as air therapy and frequent diaper changes. Rapid treatment of diaper dermatitis is possible subject to the following rules:

• Avoid prolonged contact of the baby's skin with wet diapers or diapers.
• Observe the temperature regime, prevent overheating of the skin, do not wrap the child, choose the right clothes.
• After each bowel movement and urination, wash the baby, carefully treat the skin folds.
• Give the baby air baths, leaving him without clothes for 15-20 minutes several times a day.
• Use high-quality disposable diapers that absorb moisture well.
• Change diapers every 3-4 hours.

Further treatment tactics will depend on the severity of the symptoms. Diaper dermatitis, not complicated by microbial infection, is quickly treated with proper hygienic care. If the skin is dry, flaky, softening ointments and creams with anti-inflammatory and healing effects are used. In the presence of weeping areas, creams and ointments with a drying effect, various powders are prescribed. A good result is noted when using ointments containing zinc oxide (Desitin), ointments D-Panthenol, Bepanten are popular. Drapolen cream has an excellent antiseptic, disinfectant and healing effect.

The skin of a child after hygiene procedures must be powdered with special baby powders or lubricated with oils. The use of hypoallergenic children's cosmetics is recommended. These are a variety of gels, cleansing and moisturizing lotions, body milk. A good effect on the skin is provided by baby oils after bathing, which create a protective film on the skin and treatment with creams, which include natural ingredients (glycerin, beeswax, plant extracts, mineral oils).

For the treatment of candidal diaper dermatitis, antifungal ointments are prescribed (Miconazole, Clotrimazole, Ketoconazole). The treatment regimen, duration and dosage should be recommended by the attending physician. When joining a fungal infection, hormonal drugs are not used, as they can complicate the course of the disease. Treatment should be directed not only to the external elimination of the fungus, but also to the treatment of candidiasis in the oral cavity and intestines. To do this, prescribe the drug Deflucan for oral administration.

With moderate and severe diaper dermatitis, Bepanthen ointment, which contains dexpanthenol, can be used. This component has pronounced regenerative properties, quickly heals damaged skin and restores its barrier function. The modern drug is quite safe and can be used to treat even premature babies.

When a bacterial infection is attached, it is recommended to use the drug Baneocin in the form of a powder for powders. The composition of the drug includes the antibiotics neomycin and bacitracin, which effectively cope with pathogenic microorganisms (staphylococci and streptococci). The powder should be applied to the affected areas after hygienic treatment up to 4 times a day.

Remember that the child should be shown to the doctor if the rash is pronounced and does not go away, but only intensifies after several days of active care. Look out for the following warning signs:

• Diaper rash and rash accompanied by fever
• The rash extends beyond the diaper and spreads to other areas of the body
• Weeping, blisters and pustules appear on the inflamed skin
• The child is restless, cries a lot, or is excessively sleepy

These symptoms indicate the development of complications, the addition of a secondary infection and require competent treatment. Do not self-medicate, it can aggravate the situation. Only a specialist is able to make the correct diagnosis and select effective drugs that will quickly and without harm to the health of the child cope with unpleasant symptoms.

If diaper dermatitis is accompanied by complications, a consultation with a dermatologist may be necessary, but usually the disease is treated quite easily and, if preventive measures are followed, the likelihood of a recurrence of the disease is significantly reduced.

Treatment with folk remedies

Traditional medicine recipes will help to cope with the symptoms of diaper dermatitis. Be sure to consult your doctor before using them.

An excellent drying, soothing and anti-inflammatory effect is provided by baths with the addition of a decoction of oak bark, string, celandine, sage.

Preventive measures

The main preventive measure aimed at preventing diaper dermatitis is to maintain dryness and cleanliness of the skin. Try to change diapers or diapers as often as possible, this should be done after each stool or urination in newborns and at least 3-4 times a day in older children.

Choose disposable absorbent diapers with a special layer that quickly absorbs liquid and turns it into a gel. Try to use only "breathable" diapers and select them according to size in order to avoid rubbing and squeezing the baby's delicate skin. Clothing and diapers should be made of natural cotton fabrics. They need to be washed with special children's hypoallergenic powders that do not contain alkaline components.

Give your baby air baths several times a day, leaving him naked for 15-20 minutes. Of course, the temperature in the room at this time should be comfortable for the baby. Contact with air is the most reliable and safe remedy in the treatment of diaper dermatitis.

Wash your baby's perineum thoroughly with cool water after every urination and bowel movement. After water procedures, the skin in the genital area and buttocks should be dried with soft wipes and treated with soft protective creams containing lanolin, petroleum jelly, zinc, or special oils should be applied.

Baby powder will help protect the skin from chafing and irritation. If symptoms of diaper dermatitis appear, you should stop using alkaline soap, as it dries out the skin. For washing, use a mild hypoallergenic soap, or wash the child only with warm water.

When a fungal infection is attached, along with drugs that eliminate Candida fungus, you should use powders that eliminate wetting and special creams containing antifungal components to treat the skin. During this period, in addition to regularly washing the baby, it is recommended to iron diapers and clothes with a hot iron, and wash hands thoroughly before any contact with the baby's skin.

Reconsider the diet and temporarily cancel complementary foods in the form of acidic juices, fruits and kefir. This will help reduce the acidity of the stool, which provokes severe irritation of the skin. Bathe the baby more often, adding decoctions of medicinal herbs to the water, which have anti-inflammatory and drying effects (chamomile, oak bark, celandine). These measures will help to quickly cope with the symptoms of diaper dermatitis and prevent its recurrence.

Adults often look with envy at the delicate, velvety children's skin, so thin and soft that you just want to touch it with your cheek. However, this refinement and tenderness needs enhanced protection. Otherwise, the baby's butt instantly "blooms" and begins to give him a lot of discomfort. You will learn about what diaper dermatitis is and how to deal with it from this article.

What it is

Diaper dermatitis is an inflammatory process on the skin, localized advantage in the most piquant places - in the perineum, in the sacrum, in the tender femoral and gluteal folds, in the inguinal folds of the skin. Inflammation is quite disturbing for both the child and his parents. The rash can be insignificant and quite extensive, have the appearance of separate rashes or merge into one large eczema, it can be both dry and weeping.

To combat this phenomenon, which affects six out of ten Russian babies, and if hygienic rules of care are violated, all ten, mankind invented disposable diapers, however, this only slightly reduced the number of skin diseases.

Diaper dermatitis remains one of the most common complaints that parents turn to pediatricians.

Why does it occur?

The problem has two main causes: external stimuli and internal factors. In practice, there is always a combination of both.

Internal causes

In newborns, the skin is very thin, not having such a developed degree of protection as the skin of adults. It is particularly sensitive to any influence - temperature, humidity, the presence of pathogenic microorganisms. It absorbs moisture faster, gets wet, the pores expand. This feature of the structure of the dermis is characteristic of children up to one and a half to two years old. Then the skin becomes denser and less prone to inflammation.

The most susceptible to diaper dermatitis are children who have problems with the balance of beneficial and opportunistic bacteria. These conditions sometimes occur due to prolonged use of antibiotics. Babies with reduced immunity after a disease are also more susceptible to negative local effects on the skin. Children who are genetically predisposed to allergies in general and its skin manifestations in particular often suffer from diaper dermatitis.

External causes

External irritants are well known and obvious - these are feces and urine. Diaper dermatitis always occurs due to the fact that the baby's skin comes into contact with ammonia, which is contained in the urine, with urea. But the combination of urine and feces is the most dangerous, because in this case the skin is not only injured by the aggressive environment of urine, but also infected with opportunistic microbes that come out of the intestine along with feces. Inflammation develops in conditions of a lack of air flow, which is created under a diaper or wet diaper. In such a space, it is much easier for bacteria to multiply.

The most aggressive is concentrated urine. Such it becomes during periods of fluid loss by the body.

If the child is sick, he has a fever, if he sweats, then less urine is excreted. The less urine, the more concentrated it is.

Another reason from the outside is the mechanical friction of the diaper. Irritations from diapers are quite painful, especially when urine or feces get on them. The stool itself can change acidity depending on the child's diet, and even without urine can cause quite serious skin lesions. More often, children of the second half of the year suffer from diaper dermatitis, since complementary foods, which the mother introduces from about 6 months, significantly change the composition of the intestinal contents, acidity increases, and the composition of urine when eating not only mother's milk, but also juices, changes significantly.

Auxiliary factors

A poor-quality diaper that does not hold moisture well is more likely to cause dermatitis in the intimate area than a good diaper that separates fluid from feces and is impregnated with a softening balm. But even an excellent and expensive diaper will not save the child from the inflammatory process if the parents rarely change it, allow overflow, and also wipe the child when changing the diaper, and not wash it.

Violation of hygiene rules - the most common auxiliary factor against which inflammatory processes develop under the diaper. Moreover, violations include not only insufficient water procedures, but also excessive washing, especially if parents use soap for this every time. Soap dries the skin, makes it more fragile and vulnerable, it is easier to form microcracks on it, in which pathogenic bacteria multiply perfectly.

Soap is enough to use only when the baby crap one's pants. If there was no bowel movement, you can simply wash the child with plain water. Overheating also affects the appearance of inflammation. If the room is tropical heat, then the baby sweats. Under the diaper, the temperature is higher than outside it, respectively, not only urine and feces, but also the salty environment of sweat act on the skin.

Symptoms and signs

Moms can easily identify the first symptoms of diaper dermatitis without any special knowledge in the field of medicine:

• The skin of the child turns red and visually swells. The lesion may be reddish or deep red, slightly swollen. Inflammation does not have clear delineated boundaries, it is blurry.
• Outside diaper the skin remains clean and healthy.
• The swelling is unevenly distributed. Where there was the closest contact with urine or feces, hyperemia is more pronounced. Nearby there may be "islands" of perfectly healthy light skin, alternating with other inflamed fragments.

• Inflammation changes all the time. If in the morning fragments of redness and swelling looked a certain way, then by lunchtime they can merge, decrease or increase, change their location.
• "Fresh" inflammation is characterized by the appearance of a small weeping rash. Older foci of inflammation dry up, peel off.

More "picturesque" looks like dermatitis, which is joined by a bacterial or fungal infection. In addition to all the above signs, the lesion sites are covered with a serous coating, a film, eczema with loose edges are formed. With fungal diaper dermatitis, the edges of eczema may be white or grayish.

In general, the child behaves restlessly, cries, eats less willingly and sleeps very badly. Pain, itching, tingling increase significantly immediately after the baby pees, and some time after he empties the intestines, provided that he does all this in a diaper. With a large area of ​​damage, inflammation can also affect the mucous membranes of the genital organs - under the foreskin in boys and the labia minora and the vaginal opening in girls.

Body temperature may rise slightly if the dermatitis is extensive. Small inflammatory processes are not accompanied by fever.

Diagnostics

The task of the pediatrician is not only to confirm or refute diaper dermatitis in infants, but also to distinguish it from other skin diseases - atopic or allergic dermatitis, seborrheic inflammation or contact dermatitis. These conditions require different treatment with different medications.

Diaper dermatitis, according to its characteristic visual signs, is diagnosed quite easily. It is more difficult to determine which bacterium or fungus caused secondary inflammation if there is a fact of an attached infection.

Treatment

Treatment of diaper dermatitis always begins with a review of the parents' approach to hygiene when caring for a child. It is important that the diaper be changed as often as possible without waiting for it to overflow and inflate. After a bowel movement, a diaper change is mandatory, with the obligatory washing of the child with warm soapy water. Air baths are very useful, so parents often need to remove the diaper from the child and let the skin “breathe”.

Quite often, it is possible to cope with mild diaper dermatitis with the mere observance of hygiene rules and the use of air baths.

With a more extensive lesion, which greatly worries the child, the doctor may additionally prescribe some pharmaceutical products to correct the care. In choosing drugs, he will adhere to the rule "wet - dry, dry - moisturize" . Therefore, for weeping rashes and wet eczema, drying agents, such as talker, are usually prescribed. "Tsindol" or ointment "Desitin". With dry skin in the affected areas, soft anti-inflammatory and moisturizing creams are prescribed: "Bepanten", "Drapolen" or children's "Panthenol".

If the doctor determines that a fungal infection has joined the inflammation, then he may advise nystatin ointment or Clotrimazole for topical use. With a bacterial complication - ointments with antibiotics. Quickly cure bacterial inflammation helps "Baneocin" and tetracycline ointment.

It is strictly forbidden to lubricate the inflamed areas of the skin with brilliant green, iodine, sprinkle abundantly with powder. Do not wash the child with a solution of potassium permanganate. Manual removal of dried crusts is prohibited in order to avoid additional infection.

• The diaper must be sized. Disposable panties, which are large or small, only increase the negative mechanical effect on the skin. It is especially important to choose good and high-quality diapers for a night's sleep, because the child is in them longer than during the day. Such hygiene products must have excellent ability to absorb liquid. It is best to give preference to diapers with a gel-forming outer layer. All the liquid that enters them turns into a gel, the skin of the crumbs, even with a long stay in a diaper, does not come into contact with urine.

• For daily hygiene, it is important to use only children's cosmetics and care products. Adult soap or cream is not suitable for children's skin and, in addition to the prerequisites for the development of diaper dermatitis, they also create an excellent platform for the development of contact allergies.
• When washing, it is important to ensure that so that a jet of water rinses all the folds of the skin, since urine and fecal particles that may remain in them will definitely give an inflammatory process in the most painful place - in the folded area.

• Manifestations of diaper dermatitis are stronger in children who are bottle-fed. This is due to a different acidity of the feces, which is formed in children who eat mixtures. To minimize the risks and save the baby from such a nuisance as diaper rash, you need to carefully consider the choice of the mixture itself. It is best if it is fully adapted for children up to 6 months and partially adapted for children from six months.
• If parents prefer to use gauze diapers or reusable panty diapers with fabric or gauze inserts, then they should be washed only with baby soap or a special hypoallergenic powder, then boiled for 10 minutes and only then rinsed with chilled, pre-boiled water. This will help reduce the risk of developing inflammation in the groin and genital area.

You can learn more about children's film dermatitis from Dr. Komorowski by watching the video below.

The skin of children is much softer and more sensitive than that of an adult. Therefore, it is very easy to injure her. Any factors - mechanical, chemical, biological or physical - can cause an inflammatory process.

One of the troubles that await babies from the first days of life can be called diaper dermatitis. Many mothers face this problem sooner or later. And the point here is not only the inexperience of parents or the harm from the constant use of disposable diapers. So, what is diaper dermatitis in children?

General information

Diaper dermatitis is an inflammation of the skin due to its irritation with excess moisture or feces due to errors in caring for the baby. Most often, this inflammation is localized in the inguinal folds, on the buttocks and inner thighs, that is, where the skin comes into contact with a wet diaper, diaper, and friction occurs. But sometimes the armpits, neck folds and skin behind the ears become the sites of the lesion.

Diaper dermatitis mainly affects young children. A number of factors contribute to the development of the disease: structural features of the skin (thin epidermis), underdeveloped thermoregulation function and imperfection of the immune system. Therefore, the older the child, the less often this pathology occurs, since the skin acquires protective properties over time.

The reasons

The main cause of diaper dermatitis is prolonged skin contact with various irritants due to non-compliance with personal hygiene rules. If we consider in more detail, then there are a lot of situations in which this pathology can develop.

Physical factors:

• prolonged stay of the baby in wet diapers;
• infrequent change of disposable diapers;
• low-quality diapers that do not allow the skin to breathe, and as a result, a "greenhouse effect" is created - an excellent environment for the development of microorganisms;
• improperly selected size of diapers: too small or too large begin to rub, thereby injuring the skin;
• irregular water procedures;
• infrequent washing of children's clothes;
• coarse clothing made of synthetic materials that do not allow air to pass through;
• high body temperature or hot weather create overheating of the body, and these are prerequisites for the occurrence of dermatitis.

All physical factors are triggers in the disease. Next come into force chemical and biological stimuli.

Chemical factors:

• prolonged skin irritation with sweat, urine or feces, especially with the introduction of complementary foods, when the composition and nature of the stool changes;
• digestive enzymes and bile acids found in feces;
• improper feeding of the baby, or products with biotin (vitamin H, which is responsible for the health of hair, nails and skin).

Biological factors:

• infection of microtraumas with pathogenic bacteria (especially streptococci and staphylococci) or fungi;
• antibiotic treatment, as a result of which all beneficial intestinal microflora is suppressed and fungi are activated;
• congenital allergic diseases, for example, or enteropathic acrodermatitis;
• an allergic reaction to a certain brand of diapers or baby care products - soap, cream, powder, disposable wipes, laundry detergent, etc .;

All three types of causes are closely related. And yet, pediatricians single out children who have a predisposition to this disease. These are babies with a tendency to allergies, with impaired water-salt metabolism, with very sensitive skin and high ammonia in the urine.

Types of diaper dermatitis

Depending on the type of rash, its localization and severity, several types of the disease can be distinguished:

• abrasions;

With this type of dermatitis, the baby's skin turns red only in places where clothing or diapers are rubbed. And if a secondary infection does not join the process, then it passes on its own as soon as the cause of the disease disappears.

• marginal dermatitis;

The rash occurs in places where there is friction of the edges of the diaper. Otherwise, it is no more different from the previous version of dermatitis.

• perianal dermatitis;

The name of this type speaks for itself. Redness is localized mainly around the anus. This variant of dermatitis occurs in children who are formula-fed, with the introduction of the first complementary foods, or due to diarrhea. This is due to a change in the acidity and character of the stool.

• intertrigo;

A rare type of diaper dermatitis that appears as a slight reddening of the skin due to moisture and friction. Favorite localization - deep folds in the groin and thighs.

Symptoms of the disease

Diaper dermatitis can have different severity:

• mild degree - slight hyperemia (redness) and single elements of the rash in the form of small spots and pimples; the localization of the process is limited, most often the perineum, buttocks and the upper third of the thighs suffer;
• moderate severity is characterized by more pronounced reddening of the skin, the elements of the rash become more diverse - single pustules (pustules) and erosion appear, which increases the likelihood of infection of the process;
• severe degree - the disease proceeds with complications, infection of the rash is observed; in addition to pronounced redness of the skin, its swelling, weeping and ulceration appear; the general condition of the child worsens, the body temperature rises.

The child becomes capricious and restless, sleeps badly and often wakes up. The rash in most cases is accompanied by severe itching and burning, and when touched, the baby feels pain.

Complications

If you do not start the treatment of diaper dermatitis on time, a number of complications may occur as a result of the addition of a secondary infection.

In this case, purulent-inflammatory processes affect the deeper layers of the skin, and the development of a wide variety of complications is possible:

• abscesses;
• infiltrates;
• candidal dermatitis;

Occurs during antibiotic treatment. A bright red rash is gradually replaced by small pustules. Affected skin may be dry or weepy. Such dermatitis is not treatable by conventional means and requires the appointment of special ointments.

This type of dermatitis is caused by microorganisms, in particular staphylococci. In the area of ​​​​contact of the skin with the diaper, a rash appears in the form of blisters, which dry up, and in their place a yellow-brown crust forms. Impetigo tends to spread all over the body, affecting the skin of the back and abdomen, as well as the thighs and arms.

All complications are accompanied by disturbances in the general condition of the child: fever, loss of appetite, anxiety, or, conversely, lethargy. In this case, the baby often cries and sleeps poorly.

Diagnostics

Diagnosis of uncomplicated diaper dermatitis is not difficult and is based on the clinical picture and a survey of the mother. If the doctor suspects that the disease is complicated by a secondary infection, then for a more accurate diagnosis and successful treatment, he may prescribe an additional examination:

• bacteriological seeding of material taken from the surface of the skin to determine the type of pathogen;
• general blood analysis;
• fecal analysis for.

Treatment

Treatment of diaper dermatitis is to eliminate the causes that caused the rash, and to carefully care for the child. Therefore, when starting the treatment of diaper dermatitis, parents should learn a few simple rules and change their lifestyle a little:

• refuse waterproof diapers;
• use only high-quality hygroscopic disposable diapers;
• wash the baby and change diapers after each bowel movement, but at least once every 3-4 hours even at night, or use special diapers designed for the whole night, since they contain a special moisture-absorbing material;
• make sure that the child does not stay in wet panties or a diaper for a long time;
• properly dress the baby, do not wrap up to avoid overheating, since not only the "greenhouse effect" of the diaper causes diaper dermatitis, but also the baby's sweat can have an irritating effect.

The treatment regimen depends on the severity of the process and the type of diaper dermatitis. But most often pediatricians recommend such procedures:

1. local treatment. With uncomplicated diaper dermatitis, ointments such as Bepanten and Drapolen do an excellent job. They have anti-inflammatory and antiseptic effects. After a couple of days of applying the ointment, the symptoms of the disease will weaken, or even disappear.
2. Leather processing. Before applying the ointment, as well as after each act of defecation, the child must be washed well with warm boiled water, and not just wipe the skin with wet wipes.
3. In between applying the ointment after washing, you can wipe the affected areas with infusions of herbs (chamomile or string), which are easy and quick to prepare. You need two tablespoons of herbs to pour 200 ml of boiling water and insist for 40 minutes. And then, to protect the skin from the irritating effects of urine and feces, lubricate with zinc ointment or Desitin, you can also use powder.
4. In the bath with water for daily bathing, you can add decoctions of herbs. Not bad proved infusion of oats. To prepare it, you need to pour a glass of oats with a liter of boiling water and simmer it in a water bath for about 20 minutes. Then let it brew, strain and add to bathing water.

A few more tips:

• if the dermatitis is weeping, then powder or special drying ointments are effective;
• in the presence of areas of peeling or cracks in the area affected by dermatitis, it is best to use an ointment or cream that has a softening effect and also accelerates skin regeneration;
• with candidal diaper dermatitis, ointments with an antifungal effect should be used: Clotrimazole, Ketoconazole, Miconazole, Batrafen or Cyclopirox; they are applied three times a day for a month on previously cleansed skin;
• you can not combine the use of cream and powder;
• in no case do not use hormonal ointments for the treatment of dermatitis.

With a slight redness and single pimples, there is no need to immediately consult a doctor. You can try to cope on your own, removing the errors in caring for the child.

When should you see a doctor?

• If the rash does not go away within three days, and no measures help;
• the rash spreads over the body, the process is aggravated, new elements appear - pustules, crusts, erosion;
• the general condition of the child worsens, the body temperature rises.

Prevention of diaper dermatitis

Preventive measures to prevent the appearance of diaper dermatitis are based on strict hygiene. They are aimed at keeping the baby's skin clean and dry.