Diaper Dermatitis

6 Summary

The development of containment devices (loose cloths, nappies, diapers) has led to increased awareness of epidermal barrier breakdown in the region of containment. Although fetal skin is constantly exposed to amniotic fluid and urine before birth, diaper rash is exclusively a disease of extrauterine life. Diaper rash, i.e., mild erythema and SC barrier compromise typically develops over the first few postnatal weeks. If diseases are defined broadly as conditions of discomfort affecting patients and caregivers, diaper dermatitis is likely the most common disease of infancy and early childhood. This condition is often selflimiting, commonly responsive to over-the-counter therapies, uniformly nonfatal, and yet surprisingly complex. Studies combining expert perceptual grading with sophisticated biophysical measurements indicate that the condition has an intermittent, fluctuating nature. Healing of the skin and disappearance of the rash mask a persistent compromise of the epidermal barrier. Over the past few decades, significant improvements in diaper design and gelling material in addition to improved topical medicaments have reduced the incidence of more severe diaper dermatitis. Studies of infant discomfort associated with mild rash states have not been reported. Continued focus on the common cross-cultural problem of diaper dermatitis offers scientific challenges in understanding the biological basis of epidermal barrier compromise, as well as affording many opportunities for improvement in child health and the parent/caregiver experience.