Patient information. The bottom line on diaper rash.
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The diaper-wearing population has expanded from infants and children to include adults, especially the elderly. Nurses caring for patients over a wide age range are commonly asked for advice about diapering choices, and for guidance in evaluation, prophylaxis, and treatment of diaper rashes. Two different diaper types, disposables and reusables, and the advantages and disadvantages of each are discussed. A systematic approach is presented for the nursing evaluation of common diaper rashes and their differentiation from rarer skin eruptions of the groin and perineum in diaper-wearing persons.
Diaper rash is a common infant malady. This study documents the earliest stages of rash in a cohort of 31 healthy term newborns over the first 28 days of life. The diaper area was evaluated using a standardized diaper rash grading scale. The anal, buttock, genital, intertriginous, waistband, and leg areas were assessed separately. At birth the average grade was 0.1 and none of the infants had specific features of advanced rash. Nineteen percent had dryness and/or slight redness. By day 7, 71% of infants had some features of skin compromise, giving rise to an overall grade of 0.6. Both the frequency and overall grade increased during postnatal weeks 2 and 3. Overall scores for days 21 and 28 were the same (1.1). The perianal area had the highest overall regional rash grade. Gender differences were present for the genital area only. These findings indicate that epidermal barrier breakdown is an uncommon finding at birth. Clinical signs of irritated skin in the diaper area develop progressively over the first postnatal month. A better understanding of the mechanisms conferring epidermal barrier protection at birth may be important for developing skin care products and practices to extend this protection later into life.
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Eleven open multicentre studies were conducted to evaluate the efficacy of tioconazole cream 1% as a treatment for diaper rash with or without fungal (Candida) involvement, or impetigo in neonates and infants. In the dermal candidiasis/diaper rash group, 320 patients had either tioconazole (n = 220), a comparative imidazole (n = 43), or vehicle cream (n = 57) applied to the affected area twice daily. Twenty-one impetigo patients had only tioconazole cream 1% applied three times daily to lesions. The overall cure rate (patients with both clinical and mycological cure) at the end of treatment for tioconazole treated patients was 78%, for the comparative imidazole group it was 76% and for vehicle cream it was 39%. At the long-term follow-up evaluation approximately 6 weeks after treatment for patients with diaper rash, the overall cure rate was about the same in both tioconazole- and comparative imidazole-treated patients (87% and 90%, respectively), and 14% in patients using vehicle cream. Side-effects were coincident with disease symptoms and consisted primarily of erythema localized to the treatment area; they occurred in 5.4% (13/241) of the patients who received tioconazole and in 21% (9/43) of the patients who received comparative imidazole (econazole or miconazole). No side-effects were reported in this open study for the 57 patients who used vehicle cream. The results of these studies show that tioconazole cream 1% is safe and effective for the treatment of neonates and infants with dermal candidiasis, diaper rash and impetigo.
The frequency of genito-crural candidiasis in infants presenting diaper rash, as well as the possible influence of bacterial flora in this region on the pathogenicity of Candida was studied. Skin scraping were made with sterile swabs and processed by bacteriological and mycological methods in 140 children whose ages ranged between 0 and 20 months. The most commonly found microbiological flora were Candida spp (65.7%), non hemolytic Streptococcus (18.5%), Staphylococus epidermidis (19.2%); beta hemolytic Streptococcus (12.8%) and alfa-hemolytic Streptococcus (9.2%). Of the 140 cases, 76 (54.3%) showed candidiasis associated with diaper rash and 16 (11.4%) had Candida as normal flora. C. albicans was most frequently found (66.3%) followed by C. tropicalis (19.6%). Candidiasis was more frequent in those infants that had no other associated of pathogenic flora. Factors significantly influencing the increase in the frequency of candidiasis were: A) Evolution time, which was directly proportional; B) Use of cotton diapers covered with plastic pants; C) Feeding with cow's as opposed to maternal milk; and D) Malnutrition associated with poor hygiene.
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Hair zinc concentration was determined by atomic absorption spectrophotometry in 308 normal newborn infants and 199 normal infants aged one to twelve months. Hair zinc concentration declined from 204 micrograms/gm at birth to 112 micrograms/gm at age eight months, and then rose to 144 micrograms/gm at age twelve months. Diaper rash was significantly associated with reduced hair zinc, and infants with the least hair had lower zinc levels than infants with the most hair. The data indicate that hair loss and diaper rash found in normal infants is significantly associated with a reduction in hair zinc concentration.
The authors presents 3 cases of Kawasaki disease where, in all cases, a perineal rash or rash located in the diaper area, was an initial or predominant sign. We highlight the interest of this discovery for the early and diagnostic of this disease, in both its classics and incomplete forms, and with this achieve efficiency in the preventive treatment of the cardiovascular complications.
A 4-month-old infant was seen with hypokalemic metabolic alkalosis that was associated with prior application of liberal amounts of sodium bicarbonate (baking soda) to a diaper rash. After exclusion of other etiologies of the infant's acid-base disturbance, a complete resolution occurred following discontinuation of the baking soda applications. This case report provides a reminder of the significant side effects that may result from the excessive use of a seemingly harmless household substance.
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A total of 89 normal newborn infants received 10mg oral zinc supplements daily for 4 months and 90 others received a placebo. The zinc supplemented group had a significant reduction in the incidence of diaper rash, and they gained slightly more in height and weight, although the growth differences were not significant.
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