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DIAPER RASHOleh:Stanly Pieter Thenu (2008-83-047)Chresta D. Illintutu (2008-83-048Jeane P. Andries (2008-83-035)1BAGIAN ILMU KESEHATAN KULIT DAN KELAMINFAKULTAS KEDOKTERANUNIVERSITAS HASANUDINKonsulen:Dr. Safruddin Amin, Sp.KK(K), MARS

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIKBAGIAN ILMU KESEHATAN KULIT DAN KELAMINUNIVERSITAS PATTIMURAAMBON2014Pembimbing:Dr. Dinie Ramdhani KIntroductionDiaper Rash/Diaper Dermatitis/napkin dermatitis:Inflammatory eruption of the napkin areahighly prevalent condition in infancy, although the reported prevalence varies greatly between different studies. Jordan et al.1 reported that half of children of age 1 20 months had nappy rashhighest reported prevalence of diaper dermatitis is in the 9 12-month age group

IntroductionDiaper dermatitis is the result of progressive barrier compromise and is characterized by dryness/scaling, aberrant desquamation and erythema. When the stratum corneum is exposed to prolonged wetness in an occlusive nappy environmentIntroductionThe following factors need to be considered in any etiology:Maceration by waterExcessive wetness has several effects on the stratum corneumProlonged occlusion of the skin can itself produce erythema, particularly if water is kept in contact with the skin surface FrictionUrineFecesThe combination of these factors breakdown of the stratum corneum predisposes the skin to opportunistic infection by faecal microbes diaper dermatitisIntroductionClinical manifestasiononset : during the third to the 12th week (most often), peak prevalence : between the seventh and 12th months. The most common form primary irritant napkin dermatitis confluent erythema of the convex surfaces in closest contact with the napkin that is the buttocks, the genitalia, the lower abdomen and pubic area, and the upper thighs. The deeper parts of the groin flexures are generally spared. 1

IntroductionClinical Manifestationerosive form (Jacquets dermatitis) : small vesicles and erosions, shallow, round ulcers with raised crater-like edges.variants of primary irritant napkin dermatitis secondary invasion by C. albicans.secondary invasion by C. albicans erythema may be more intense, will no longer spare the deeper parts of the flexural folds. IntroductionTreatment:Prevention is the best treatmentemolientZinc oxideTopical corticosteroidAnti-fungi

DiagnosisHistoryHigh prevalence between 6 and 12 monthhistory concerning skin & diaper care predisposing factorshistory of present illness, associated symptoms, & physical examination a clinical diagnosis of irritant contact diaper dermatitisOther condition : mouth must be inspected for thrush skin and nails examined for other lesions

AnamnesisA complete history includes gestational and birth historyfamily historyExposures during pregnancymedications, illicit drugs, and infectious diseases such as varicella and sexually transmitted diseases

Physical examintationIrritant diaper dermatitis (Classic findings)redness and scaling or maceration of the groin with sparing of the skin creaseserythematous, moist, and sometimes scaly patches on the convexities area (genitalia and buttocksareas in closest contact with the diaper. Shallow erosions sometimes.Diaper rash in convex area

Candida secondary infectionsecond most common typebright red erythematous,moist papules, patches, and plaques that tend to involve body foldsseborrheic dermatitis , confluent erythema with greasy, white-yellow scale, on the scalp (cradle cap) intertriginous areas are often moist or maceratedJacquets dermatitis well-demarcated, punched-out ulcers erosions with elevated borders.

diaper dermatitis seboroik. Jacquets diaper dermatitis.

Additional ExamKOH candidainfeksi herpes Tzanck Virus direct fluorescent antibody (DFA)

Algorithm diagnosis diaper dermatitis

TreatmentPrevention is the best treatmentElements of successful treatment include the following: Attention to the napkinsDisposable napkinsContinuous administration of emollient from certain disposable napkins.Frequency of napkin changesCare of washable napkinsRoutine skin care in the napkin area.Specific therapy

Specific therapyTopical corticosteroidHidrokortison 1%Strong corticosteroid should be avoidedCovered by emollientAntifungalNystatinClotrimazone, Ketokonazole, MiconazoneCovered by emollientConsider adding hydrocortisone 1%Topical and systemic Antibiotic

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