Introduction to Diaper Dermatitis

Skin No Responses »
Nov 302011

Diaper dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations and is a prototypical example of irritant contact dermatitis.

Pathophysiology

Diaper rash affects the areas within the confines of the diaper. Increased wetness in the diaper area makes the skin more susceptible to damage by physical, chemical, and enzymatic mechanisms. Wet skin increases the penetration of irritant substances. Superhydration urease enzyme found in the stratum corneum liberates ammonia from cutaneous bacteria. Urease has a mild irritant effect on nonintact skin. Lipases and proteases in feces mix with urine on nonintact skin and cause an alkaline surface pH, adding to the irritation. (Feces in breastfed infants have a lower pH, and breastfed infants are less susceptible to diaper dermatitis.) The bile salts in the stools enhance the activity of fecal enzymes, adding to the effect.

Age

Diaper dermatitis commonly affects infants, with peak incidence occurring when the individual is aged 9-12 months. One study determined that at any given time, diaper dermatitis is prevalent in 7-35% of the infant population.

Diaper dermatitis can affect persons of any age who wear diapers, in particular, elderly people.

Physical Examination

Patients with diaper dermatitis present with an erythematous scaly diaper area often with papulovesicular or bullous lesions, fissures, and erosions.

The eruption may be patchy or confluent, affecting the abdomen from the umbilicus down to the thighs and encompassing the genitalia, perineum, and buttocks. Genitocrural folds are spared in Continue reading »

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Introduction to Erythema Multiforme

Skin No Responses »
May 062011
Erythema Multiforme Minor
  • This condition is characterized by erythematous papules that evolve into target lesions with dusky centers. Some oral lesions may be present.
  • The most common precipitant is HSV infection. It may also be drug-induced.
Treatment
  • Antihistamines provide symptomatic relief.
  • Systemic steroids may be helpful if given early.
  • Prophylactic acyclovir may be useful to prevent recurrent HSV-related disease.
Erythema Multiforme Major (Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis)
  • In Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), marked erythema or target lesions rapidly progress to blistering and epidermal sloughing.
Treatment
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Atopic Dermatitis (Eczema)

Immunology, Skin No Responses »
Dec 262010
  • Atopic dermatitis is a chronic relapsing and remitting inflammatory skin disease characterized by dermatitis with typical morphology and distribution.
  • Eczema is a generic term for a constellation of clinical signs, whereas atopic dermatitis is a term that specifically connotes an allergic contribution to the etiology of the eczema.
  • The overall prevalence of atopic dermatitis in the United States is 17% among school-aged children, leading to considerable disease-related morbidity, including irritability, secondary skin infections, sleep disturbance, school absenteeism, and poor self-image.
History
  • Age of onset is a consideration, with 45% of affected individuals manifesting atopic dermatitis in the first 6 months of life, 60% by the first year, and 85% by school age.
  • Pruritus is a cardinal feature of eczema, often described as the “itch that rashes.” Scratching leads to further compromise in the skin barrier and augments inflammation.
  • Xerosis (dry skin) also involves nonlesional skin. (In other conditions, commonly mistaken for atopic dermatitis (seborrheic dermatitis, nummular eczema, and psoriasis), the uninvolved skin is generally healthy.)
  • Patients may have a personal and family history of atopy (asthma, hay fever, food allergy).
  • Exacerbating factors include food allergens (most frequently egg, milk, wheat, soy, peanut, tree nuts, shellfish) and inhalant allergens (e.g., pet dander, house dust mite).
  • Systemic involvement, with failure to thrive, chronic diarrhea, and/or recurrent infections should prompt consideration of underlying systemic disease, such as immunodeficiency (e.g., Wiskott-Aldrich syndrome, Netherton syndrome, immune dysregulation polyendocrinopathy enteropathy X-linked (IPEX) syndrome, and hyper-IgE syndrome), or malabsorption (e.g., zinc deficiency or cystic fibrosis).
Physical Examination
  • Xerosis
  • Morphology of lesions
    • Acute lesions: pruritic papules with excoriation and serous exudation
    • Chronic lesions: lichenified papules and plaques
    • Superficial linear abrasions from scratching
    • Indistinct lesional borders, unlike that of psoriasis

  • Areas of involvement. Although atopic dermatitis may appear anywhere on the body, characteristic patterns include:
    • Infants: cheeks, forehead, and extensor surface of extremities
    • Children/adolescents: flexor surface of extremities popliteal and antecubital fossae, and ventral surface of wrists and ankles Continue reading »
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