The Etiology and Treatment of Ammonia Dermatitis of the Gluteal Region of Infants

Abstract

All those who treat infants and young children encounter with more or less frequency instances in which the diapers after having been wet with urine for several hours give off the odor of ammonia.Frequently the odor is faint and the condition occurs in infants otherwise well and thriving. In some cases the ammoniacal odor is very pronounced and accompanied by irritation of the skin of the diaper region usually more marked over the buttocks and inner surfaces of the thighs. The lesion may consist only of diffuse redness but not infrequently vesicles and papules with more or less excoriation occur. There seems no doubt that the dermatitis is caused directly by the ammonia. Attention was called to the condition by Southworth 1 and it has been discussed in some detail by Zahorsky 2 and more recently by Brennemann.3 The latter observer has described especally the ulceration at the external urinary meatus that may occur in circumcised male children in association with the ammoniacal diaper, a lesion noted previously by Zahorsky.The characteristic lesions of the diaper region have long been recognized and have been described under a variety of names, but have not generally been attributed to ammonia in the napkin. It was formerly frequently confused with the lesions of hereditary syphilis and Parrot, who was one of the first to describe the condition, mistook it for a lenticular syphilide. Jacquet,4 however, clearly differentiated these eruptions of the diaper region from syphilitic lesions. He divided them into simple erythematous, erythemato-vesicular or erosive, papular or post-erosive and ulcerative forms all of which are stages of one process and may overlap or coexist in the same patient. Finkelstein 5

A clinical study of neonatal dermatosis

“…We noted a higher frequency among females (75%) and preterm babies (11.5%) as compare to term babies (4.79%) and these observations are consistent with Osburn et al and Amir et al who noted a similar relationship. 25,26 Head and neck was the predominant site for hemangioma in our study (62.5%) similar to previous studies Chiller et al and Senthilkumar.…”

Diaper Dermatitis: Frequency and Severity Among a General Infant Population

“…Variation in the frequency of diaper rash with infant age was previously observed (2,4,11). In 1921, Cooke (12) noted that rash was most common in the latter part of the first year of life. No previously reported attempts have been made to relate the condition to the age of the infant using standard maturity curves.…”

Etiologic Factors in Diaper Dermatitis: The Role of Urine

“…Ammonia was first implicated in the genesis of diaper dermatitis by Zahorsky (8), who noted a correlation between the odor of ammonia on diapers and the presence of diaper dermatitis. Cooke (9) subsequently isolated from the feces of infants an organism, Brevibacterium ammoniagenes, which is capable of generating ammonia from urea. Applied to his arm under occlusion, the organism produced erythema in the presence but not absence of 1% urea.…”