P NAPPY RASH

Prevalence and Severity of Diaper Dermatitis

Pediatric Dermatology

 1 Expert Comment

TAKE-HOME MESSAGE

• In this study, diaper dermatitis was studied in 1791 infants from China, the US, and Germany. Per a digital platform scale, the areas of highest degree of diaper dermatitis in all children was the perianal area followed by intertriginous, then genital, then buttocks areas. The lowest prevalence of diaper dermatitis in children 2 to 8 months of age was in China (1.3%), followed by the US (8.7%), and followed by Germany (14.9%). Skin pH and transepidermal water loss (TEWL) also followed this trend and were inversely correlated with diaper dermatitis severity. Chinese caregivers tended to perform no skin cleaning after a urine-only diaper (46.3%) compared with US caregivers who tended to use wipes most frequently (83.9%). For diapers containing stool, most Chinese caregivers cleaned using water with or without soap (70.6%) or, less often, baby wipes (23.4%). In contrast, in the US and Germany, wipes were used most often (94.9% and 74.5%, respectively).

• This study across three different countries demonstrates significant differences in diaper dermatitis prevalence. Higher skin pH and increased TEWL were correlated with dermatitis severity. These differences may be in part explained by varying diapering practices among countries, especially with respect to the use of cleaning practices after soiling.

– Margaret Hammond, MD

 Dermatology

Written by

 

 

Sarah L Chamlin MD

This Procter and Gamble-funded study was designed to investigate the prevalence and severity of diaper dermatitis (DD) in 1719 infants in China, the US, and Germany. DD was most frequent in the perianal area compared with other areas covered by the diaper. Diaper area pH and TEWL were lowest in the Chinese babies, and these infants had the lowest rate of diaper dermatitis. This was attributed to regular use of prophylactic topical products, thorough cleaning after stooling, and less time in wet overnight diapers.

I suggest a few helpful takeaways from this article. When diapering, no skin cleaning is necessary for a urine-only diaper change because over-cleaning of the skin, particularly with commercial wipes, may contribute to an increased TEWL and pH by disruption of skin structural integrity. Also, application of a topical barrier cream may be advantageous in DD prevention by preventing skin overhydration and protecting skin from stool enzymes. These common-sense findings easily translate into simple instructions for our diapered patients.

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OBJECTIVES

To compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.

METHODS

A cross-sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet-training habits, exclusively diaper-wearing infants were recruited between ages 2-8 months in China and 2-18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.

RESULTS

Diaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2-8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine-only diaper changes, and Chinese infants spent the least time in an overnight diaper.

CONCLUSIONS

These data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.