Differentials
Allergic contact dermatitis
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms.
INVESTIGATIONS
Patch testing to determine offending antigenic allergen.
Seborrheic dermatitis
SIGNS / SYMPTOMS
Erythematous papules and plaques associated with yellow scales in diaper area, and cradle cap.[14]
INVESTIGATIONS
Clinical diagnosis. Testing not usually required.
Psoriasis
SIGNS / SYMPTOMS
Thick silvery scales in groin and gluteal cleft, accompanied by nail abnormalities.
INVESTIGATIONS
Clinical diagnosis. Testing not usually required.
Granuloma gluteale infantum
SIGNS / SYMPTOMS
Macerated skin with purple papulonodular lesions.
INVESTIGATIONS
Clinical diagnosis. Testing not usually required.
HIV
SIGNS / SYMPTOMS
Recalcitrant rash in diaper area; recurrent infections; other symptoms and signs of this disease.
INVESTIGATIONS
Positive HIV antibody screen.
Nutritional deficiencies
SIGNS / SYMPTOMS
Recalcitrant rash in diaper area and perioral area; faltering growth; developmental delay; alopecia; behavioral abnormalities.
INVESTIGATIONS
Low levels of deficient nutrient (i.e., zinc, biotin, protein).
Immune deficiencies
SIGNS / SYMPTOMS
Severe, recalcitrant rash associated with generalized eczema, faltering growth, recurrent infections.
INVESTIGATIONS
Abnormal immunologic workup, specific to underlying disorder.
Langerhans cell histiocytosis
SIGNS / SYMPTOMS
Chronic scaly papules and nodules in groin, face, trunk; petechiae/hemorrhagic lesions; palm and sole involvement; symptoms of other organ involvement.[14]
INVESTIGATIONS
Skin biopsy reveals Birbeck granules.
Urea cycle defect
SIGNS / SYMPTOMS
Recalcitrant diaper rash associated with perioral involvement; developmental delay; metabolic derangements.
INVESTIGATIONS
Abnormal serum amino acid analysis, elevated serum ammonia level associated with a normal anion gap and a normal serum glucose level are found in urea cycle defects.
Child abuse and neglect
SIGNS / SYMPTOMS
Scalded skin, bruising, or object-shaped lesions in diaper area; poor hygiene; developmental delay.
INVESTIGATIONS
Clinical diagnosis. Testing not usually required.
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