Revisiting infant nappy dermatitis: Causes and preventive care

Abstract

Cleansing and care of the nappy area is a subject of concern to parents, health professionals and infant care product manufacturers alike. Nappy rash, or nappy dermatitis, is an inflammatory skin reaction of variable severity affecting the abdomen, buttocks, perianal and perineal areas. It is a common condition in infancy affecting more than half of all children, to some degree, before the age of 2 years. While seldom serious, it can be distressing for infants and their parents. The aetiology is multifactorial, involving factors that together impair skin barrier functionality. Known factors include over-hydration of the stratum corneum, raised pH and over-vigorous cleaning, which predisposes the skin to tissue loss and inflammation. Despite the ubiquity of this condition, there is a lack of unequivocal empirical data about best care practices; this situation leaves health professionals and parents in a quandary. Current best evidence and professional consensus supports: gentle cleaning using only specifically designed products, if any; frequent nappy changes; nappy-free periods; using modern superabsorbent nappy liners; and protecting the skin using a barrier product. Although it is not definitive, this information can be used by midwives to inform their conversations with parents about nappy area cleaning.

Neonatal skin care: Developments in care to maintain neonatal barrier function and prevention of diaper dermatitis

“…Diaper rash is a potentially severe and ongoing problem despite modern diaper technology, with reported incidence ranging from 25% within the first 4 weeks of life to as much as 100% at some point in infancy . The results demonstrate that any practice that keeps urine and feces away from the skin and that reduces the abrasion will reduce the incidence of diaper dermatitis.…”

“…Diaper dermatitis is a broad term used to describe inflammatory changes of variable severity in the skin of the diaper area, namely the lower abdomen, buttocks, perianal, and perineal areas . Clinical studies generally assess the presence of diaper dermatitis, as distinct from other skin disorders potentially affecting the same area, according to features of impacted skin integrity (ulceration, scaling), rash (papules, edema), and redness (spotty, continuous) .…”

“…Within the literature, there is considerable variation in reported frequency of diaper dermatitis, in part due to study methodology variation and differences in the age of studied cohorts. Estimations range from 25% of infants to the majority of children being affected to some degree before the age of 2 years . A US survey of 482 neonatal units looking at extremely low birthweight babies found that an average of 21% suffered skin breakdown during the first week of life.…”

“…The majority of diaper dermatitis is irritant contact dermatitis, 3 with no single causative factor; rather, the skin is subject to a complex interplay of potentially damaging factors. 1,4 Neonates with diaper dermatitis demonstrate behavioral changes such as increased crying, agitation, and changes in eating and sleeping patterns, which suggest emotional and physical distress. 5 The negative impact can extend beyond the affected individual, with studies highlighting parental guilt in response to diaper dermatitis in their charges.…”

“…Estimations range from 25% of infants to the majority of children being affected to some degree before the age of 2 years. 1,7,8,9,10 A US survey of 482 neonatal units looking at extremely low birthweight babies found that an average of 21% suffered skin breakdown during the first week of life. The authors also identified reduced rates in centers that had skin care protocols that limited adhesives and liberally used barrier cream.…”