Etiology
Diaper rash is most likely due to irritant contact dermatitis. The key irritants are moisture from urine and feces as well as fecal enzymes (ureases, proteases, and lipases). Other potential irritants include diaper components, friction produced by diapers themselves, caregiver's repeated wiping of the area, or application of baby care products.[7] Components of disposable diapers that have been implicated as potential antigenic triggers include dyes, fragrances, rubber, glue, and other chemicals used in the manufacturing process. Preservatives found in toilet tissues can also be sensitizers.[8]
Infections can exacerbate or cause diaper rash. The main infectious etiologies include Candida albicans, Staphylococcus aureus, and enteric organisms. Other infectious agents implicated include coxsackie virus, herpes simplex virus, and HIV; parasites such as pinworms and scabies; and other fungi leading to tinea corporis.
Underlying dermatologic disorders, such as allergic contact dermatitis, seborrheic dermatitis, psoriasis, granuloma gluteale infantum, lichen sclerosis, and infantile granular parakeratosis, are associated with the development of diaper rash.
Unusual etiologies include nutritional deficiencies, cystic fibrosis, urea cycle defects, immunodeficiencies, and histiocytosis.
Pathophysiology
Fecal enzymes and moisture from urine and feces serve as triggers of an immunologic reaction in the occluded diaper area. The increased pH of the skin associated with diaper-wearing further activates the enzymes.[9] The resultant inflammatory reaction due to pro-inflammatory chemo- and cytokines, leads to skin breakdown.[10] Allergic contact dermatitis involves an immunologic response that produces rash within 12-24 hours after reexposure to the offending agent.[11]
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