Dermatitis, diaper rash; a bacteriologic study of the diaper region.
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Cloth diapers, cellulose core diapers (conventional disposable diapers), and cellulose core diapers containing absorbent gelling material were examined for their effects on diaper rash and skin microbiology of normal infants and infants with atopic dermatitis in a 26-week double-blind clinical trial. Infants with atopic dermatitis wearing the diapers containing absorbent gelling material had significantly lower diaper rash grades than infants with atopic dermatitis wearing cloth diapers at five of eight grading visits. Infants with atopic dermatitis wearing conventional cellulose core diapers had statistically less rash at one of eight visits. There was no statistically significant difference between diaper types at three of the eight visits. At no time did the cloth group have less diaper rash than the conventional cellulose or absorbent gelling material disposable diaper group. A statistical correlation between the severity of general atopic dermatitis outside the diaper area and the diaper rash condition under the diaper occurred only in the atopic dermatitis group wearing cloth diapers. Isolation of microorganisms from the intact, uninvolved skin surface both inside and outside the diaper showed no biologically significant changes in the presence or numbers of selected skin organisms. Repeated isolation, at multiple grading visits of Staphylococcus aureus from uncompromised skin inside the diaper area was infrequent but correlated with the diagnosis of atopic dermatitis when observed.
Etiologic factors in the development of episodic diaper dermatitis include skin wetness and skin damage from fecal enzymes. In addition, when urine and feces mix, the activities of fecal enzymes increase as the pH rises from production of ammonia. An improved disposable diaper has been developed to provide better control of these factors by improved wetness and pH control. The improved diaper contains absorbent gelling materials (AGMs) blended into the diaper's cellulose core. AGMs are nontoxic, cross-linked polyacrylate polymers. They bind water tightly, give pH control by providing a buffering capacity, and in a diaper help to segregate urine and feces, thereby reducing the potential for increases in pH from ammonia production. To assess the effectiveness of this diaper, four 16-week clinical home-use tests were conducted with the AGM disposable versus conventional cellulose core disposable and home-laundered cloth diapers. Rigid group randomized stratification of infant maturity, diet, and initial level of diaper dermatitis provided control of factors other than the diaper that impact on development of diaper dermatitis. Skin wetness as measured by transepidermal water loss immediately after diaper removal, skin pH, and blinded visual evaluation of diaper dermatitis were used as skin condition measures. The use of AGM disposable diapers was associated with significantly reduced skin wetness and closer to normal skin pH as compared with the use of conventional disposable or home-laundered cloth diapers. Considered as an aggregate, the four clinical studies showed that AGM disposable diapers provide a better diaper environment and are associated with significantly lower degrees of diaper dermatitis than conventional disposable and home-laundered cloth diapers.
Common diaper dermatitis is a group of skin disorders that result from attack of the skin by physical, chemical, enzymatic, and microbial factors in the diaper environment. The integrity of healthy skin is compromised by the very nature of the diaper environment, and normal intact skin therefore remains an elusive goal of current diapering practices. Moist occlusion promotes miliaria, and causes an increase in the coefficient of skin friction. Skin hydration and an increase in skin pH result in impaired barrier function, and fecal enzymes begin to attack the skin, further degrading its normal ability to cope with its environment. Skin in this weakened state is susceptible to a variety of biological, chemical, and physical insults that can cause or aggravate diaper dermatitis. These include attack of the skin by fecal enzymes and other irritants in urine and feces, mechanical abrasion, and infection by C. albicans. Diapering is unquestionably an effective and convenient way of localizing an infant's excreta. Unfortunately, infant skin was not designed to operate continuously in the resulting environment, and is frequently unable to weather this assault. However, by improving the inherently adverse relationship between diapers and diapered skin, one can have a significant effect on the incidence and severity of diaper dermatitis. A diaper that keeps skin drier will result in skin that is less permeable to irritants, supports less microbial growth, is less susceptible to chafing damage, and has less contact with irritants in urine and feces. A diaper that maintains the environment closer to the normal acidic pH of skin will promote skin that is less permeable to irritants, and reduce the irritancy of fecal enzymes. Finally, a diaper that limits the mixing and spreading of urine and feces will result in less potentiation of enzyme activity and less contact of the skin with fecal irritants. Diaper dermatitis, by definition, cannot exist in the absence of diapers. Moreover, diaper dermatitis will become less troublesome for the infant population to the degree that diapered skin can be provided an environment closer to that of undiapered skin.
BACKGROUND: Diaper dermatitis is a common childhood affliction. Aiming to help reduce the prevalence of this problem, we have advanced in our development of a novel diaper that delivers dermatological formulations to help protect the skin from over-hydration and irritation. OBJECTIVE: To determine the clinical benefits of a novel disposable diaper designed to deliver a zinc oxide and petrolatum-based formulation continuously to the skin during use. METHODS: All studies were independent, blinded, randomized clinical trials. Study A was conducted to confirm transfer of the zinc oxide/petrolatum (ZnO/Pet) formulation from the diaper to the child's skin during use. Children wore a single diaper for 3 h or multiple diapers for 24 h. After the use period, stratum corneum samples were taken from each child and analysed for ZnO/Pet. Study B evaluated the prevention of skin irritation and barrier damage from a standard skin irritant (SLS) in an adult arm model. Study C evaluated skin erythema and diaper rash in 268 infants over a 4-week usage period. One half of the infants used the ZnO/Pet diaper, while the other half used a control diaper that was identical except for the absence of the ZnO/Pet formulation. RESULTS: The ointment formulation and ZnO transferred effectively from the diaper to the child's skin during product use. Transfer of ZnO increased from 4.2 microg/cm2 at 3 h to > 8 microg/cm2 at 24 h. Exposure to the formulations directly on adult skin prior to an irritant challenge was associated with up to a 3.5 reduction in skin barrier damage and skin erythema. Greatest reductions were seen for the ZnO containing formulations. Wearing of the formulation treated diaper was also associated with a significant reduction in skin erythema and diaper rash compared to the control product. CONCLUSIONS: The results demonstrated the clinical benefits associated with continuous topical administration of a zinc oxide/petrolatum-based formulation by this novel diaper.
Diaper choice (cloth vs. disposable) has become a controversial issue with increased public concern for the environment. One hundred and twenty-four consecutive mothers were surveyed during the postpartum period about diaper choice. Six percent reported physician/nurse discussion of diaper choice during prenatal care. Seventy-seven percent planned to use disposable diapers only. Twenty-two percent planned to use cloth diapers or a combination of cloth and disposable diapers. Major reasons for choice of disposables included convenience, avoidance of safety pins and cleanliness. Mothers selecting cloth or a combination cited environmental concerns, low cost and cleanliness as reasons for their choice. Factors found to be significantly associated with choice of cloth or combination were older maternal age, use of cloth with other children, and perception that disposables are more expensive. No significant association could be demonstrated between diaper choice and several demographic variables, breastfeeding, or knowledge of the environmental impact of disposables. An educational intervention promoting the use of cloth diapers did not influence diaper choice at two months. Most mothers have made a diaper choice by the time an infant is born. Providers of prenatal care seldom discuss diaper choice with pregnant women. An educational intervention to promote choice of cloth diapers had no effect on the diaper choices made by our population.