An 18-month-old African- American infant had a 3-month history of a pruritic rash in the diaper region. Previous treatments with zinc oxide ointment, 1% hydrocortisone cream, nystatin powder, clotrimizole cream and oral antibiotics weren’t helpful. The patient had occasional episodes of diarrhea, and the mother had eczema. On examination there were scattered papules and lichenified areas on the scrotum with sparing of the inguinal creases. Given the history and physical findings, we considered a form of irritant dermatitis with a possible underlying atopy. A mid-potency corticosteroid cream was prescribed, and the mother was instructed to keep the infant’s diaper area clean and dry. On Return Visit Three weeks later when the mother returned with her baby, he was asymptomatic. At this point, we noticed ulcerated papules and nodules with erosions in the diaper area (see photo). The inguinal folds were spared, and no satellite lesions were noted. The mother said that her baby’s pruritus had gone away and that he seemed to be more comfortable.Our clinical impression was Jacquet’s erosive dermatitis. We discontinued topical steroids and stressed the need for frequent diaper changes. We treated him with the hydrocortisone cleanser Aquanil and Aquaphor ointment. The eruption resolved in 2 weeks, with only a faint residual hyperpigmentation. About Jacquet’s Erosive Dermatitis Irritant diaper dermatitis results from the irritating effects of mixing urine with feces. Urine in the presence of fecal urease becomes more alkaline due to the production of ammonia. Fecal proteases, lipases and ureases are then activated. These activated enzymes directly irritate the skin and increase its permeability to other low molecular weight irritants. Jacquet erosive dermatitis, also called dermatitis syphiloides posterosiva, is a severe and complicated form of irritant diaper dermatitis. It’s more frequently seen in children with incontinence due to spina bifida or after surgery for Hirschsprung disease. It may also be seen in association with chronic diarrhea of different etiologies. Clinically, there are erosive ulcerations and nodules with raised crater-like edges. In most cases these are asymptomatic and usually aren’t secondarily infected. Some authors consider Jacquet’s erosive dermatitis on a spectrum with perianal pseudoverrucous dermatitis and granuloma gluteale infantum. All of which may occur in association with chronic severe diarrhea. As the name implies, in perianal pseudoverrucous dermatitis the papules and nodules are located at the perianal area. Most of these cases are resolved when incontinence is improved. Granuloma gluteale infantum may represent an unusual inflammatory response to long-standing irritation, candidiasis or fluorinated corticosteroids. It’s also usually asymptomatic. The characteristic lesions are uniform, reddish-purple oval nodules, which tend to favor the convexities. They are not confined to the gluteal area and may be seen at other sites. Getting Control of the Condition The cornerstone of treatment of diaper dermatitis remains the control of moisture. Frequent changes and the use of very absorbent diapers, or diapers with absorbent gelling materials usually have a beneficial effect. Mild non-soap cleansers and barrier ointments are very helpful. Erythema and inflammation can be managed with low-potency topical corticosteroids. When secondary Candida albicans infection is present, a topical antifungal agent is beneficial.
Diaper Area Irritation
An 18-month-old African- American infant had a 3-month history of a pruritic rash in the diaper region. Previous treatments with zinc oxide ointment, 1% hydrocortisone cream, nystatin powder, clotrimizole cream and oral antibiotics weren’t helpful. The patient had occasional episodes of diarrhea, and the mother had eczema. On examination there were scattered papules and lichenified areas on the scrotum with sparing of the inguinal creases. Given the history and physical findings, we considered a form of irritant dermatitis with a possible underlying atopy. A mid-potency corticosteroid cream was prescribed, and the mother was instructed to keep the infant’s diaper area clean and dry. On Return Visit Three weeks later when the mother returned with her baby, he was asymptomatic. At this point, we noticed ulcerated papules and nodules with erosions in the diaper area (see photo). The inguinal folds were spared, and no satellite lesions were noted. The mother said that her baby’s pruritus had gone away and that he seemed to be more comfortable.Our clinical impression was Jacquet’s erosive dermatitis. We discontinued topical steroids and stressed the need for frequent diaper changes. We treated him with the hydrocortisone cleanser Aquanil and Aquaphor ointment. The eruption resolved in 2 weeks, with only a faint residual hyperpigmentation. About Jacquet’s Erosive Dermatitis Irritant diaper dermatitis results from the irritating effects of mixing urine with feces. Urine in the presence of fecal urease becomes more alkaline due to the production of ammonia. Fecal proteases, lipases and ureases are then activated. These activated enzymes directly irritate the skin and increase its permeability to other low molecular weight irritants. Jacquet erosive dermatitis, also called dermatitis syphiloides posterosiva, is a severe and complicated form of irritant diaper dermatitis. It’s more frequently seen in children with incontinence due to spina bifida or after surgery for Hirschsprung disease. It may also be seen in association with chronic diarrhea of different etiologies. Clinically, there are erosive ulcerations and nodules with raised crater-like edges. In most cases these are asymptomatic and usually aren’t secondarily infected. Some authors consider Jacquet’s erosive dermatitis on a spectrum with perianal pseudoverrucous dermatitis and granuloma gluteale infantum. All of which may occur in association with chronic severe diarrhea. As the name implies, in perianal pseudoverrucous dermatitis the papules and nodules are located at the perianal area. Most of these cases are resolved when incontinence is improved. Granuloma gluteale infantum may represent an unusual inflammatory response to long-standing irritation, candidiasis or fluorinated corticosteroids. It’s also usually asymptomatic. The characteristic lesions are uniform, reddish-purple oval nodules, which tend to favor the convexities. They are not confined to the gluteal area and may be seen at other sites. Getting Control of the Condition The cornerstone of treatment of diaper dermatitis remains the control of moisture. Frequent changes and the use of very absorbent diapers, or diapers with absorbent gelling materials usually have a beneficial effect. Mild non-soap cleansers and barrier ointments are very helpful. Erythema and inflammation can be managed with low-potency topical corticosteroids. When secondary Candida albicans infection is present, a topical antifungal agent is beneficial.
An 18-month-old African- American infant had a 3-month history of a pruritic rash in the diaper region. Previous treatments with zinc oxide ointment, 1% hydrocortisone cream, nystatin powder, clotrimizole cream and oral antibiotics weren’t helpful. The patient had occasional episodes of diarrhea, and the mother had eczema. On examination there were scattered papules and lichenified areas on the scrotum with sparing of the inguinal creases. Given the history and physical findings, we considered a form of irritant dermatitis with a possible underlying atopy. A mid-potency corticosteroid cream was prescribed, and the mother was instructed to keep the infant’s diaper area clean and dry. On Return Visit Three weeks later when the mother returned with her baby, he was asymptomatic. At this point, we noticed ulcerated papules and nodules with erosions in the diaper area (see photo). The inguinal folds were spared, and no satellite lesions were noted. The mother said that her baby’s pruritus had gone away and that he seemed to be more comfortable.Our clinical impression was Jacquet’s erosive dermatitis. We discontinued topical steroids and stressed the need for frequent diaper changes. We treated him with the hydrocortisone cleanser Aquanil and Aquaphor ointment. The eruption resolved in 2 weeks, with only a faint residual hyperpigmentation. About Jacquet’s Erosive Dermatitis Irritant diaper dermatitis results from the irritating effects of mixing urine with feces. Urine in the presence of fecal urease becomes more alkaline due to the production of ammonia. Fecal proteases, lipases and ureases are then activated. These activated enzymes directly irritate the skin and increase its permeability to other low molecular weight irritants. Jacquet erosive dermatitis, also called dermatitis syphiloides posterosiva, is a severe and complicated form of irritant diaper dermatitis. It’s more frequently seen in children with incontinence due to spina bifida or after surgery for Hirschsprung disease. It may also be seen in association with chronic diarrhea of different etiologies. Clinically, there are erosive ulcerations and nodules with raised crater-like edges. In most cases these are asymptomatic and usually aren’t secondarily infected. Some authors consider Jacquet’s erosive dermatitis on a spectrum with perianal pseudoverrucous dermatitis and granuloma gluteale infantum. All of which may occur in association with chronic severe diarrhea. As the name implies, in perianal pseudoverrucous dermatitis the papules and nodules are located at the perianal area. Most of these cases are resolved when incontinence is improved. Granuloma gluteale infantum may represent an unusual inflammatory response to long-standing irritation, candidiasis or fluorinated corticosteroids. It’s also usually asymptomatic. The characteristic lesions are uniform, reddish-purple oval nodules, which tend to favor the convexities. They are not confined to the gluteal area and may be seen at other sites. Getting Control of the Condition The cornerstone of treatment of diaper dermatitis remains the control of moisture. Frequent changes and the use of very absorbent diapers, or diapers with absorbent gelling materials usually have a beneficial effect. Mild non-soap cleansers and barrier ointments are very helpful. Erythema and inflammation can be managed with low-potency topical corticosteroids. When secondary Candida albicans infection is present, a topical antifungal agent is beneficial.
