D: Prevention, diagnosis, and management of diaper dermatitis

pH of the skin that is associated with diaper wearing further activates the destructive enzymes. A child is at greatest risk of developing an irritant contact dia-per rash in the first 2 years of life most likely because during these early childhood years, more time is spent in a diaper, less objection is raised by the child when soiling occurs and more frequent uri-nations and defecations occur daily. Any aged indi-vidual who requires the use of diapers on a long-term basis will develop some skin irritation at some point in time. The majority of newborns display mild dia-per dermatitis by 1 week of age with increasing severity by age 3 weeks.4 Other irritants that promote skin breakdown in the perineum include glue used in diaper manufac-turing 5 and friction produced by the diapers them-selves or by the caregiver’s application of baby care products.4 A contact dermatitis due to chemical exposure of the buttock region after ingestion of a senna-containing laxative has also been reported.6 Infections Candida albicans may be isolated in up to 80 % of infants with perineal skin irritation that persists for 3 or more days.7 Children with diaper dermatitis are more likely to be colonized with yeast in the peri-anal, inguinal, and oral regions compared to unaf-fected children.8 The exact role that gastrointestinal colonization with C albicans has on the development or recurrence of diaper dermatitis is unknown.9 Conditions that are known to increase the likelihood of secondary yeast infection include antibiotic admin-istration, immunodeficiencies, and diabetes mellitus. Bacteria such as Staphylococcus aureus or group A streptococci can cause eruptions in the diaper area. S aureus colonization is more likely in children with atopic dermatitis and in children with diaper rash versus those without diaper rash.8 Other bacte-ria that can lead to inflammation of the vagina and surrounding tissues (vulvovaginitis) include Shigella, Escherichia coli, and Yersinia enterocolitica