Clinical Signs and Symptoms of Diaper Dermatitis: A Review

Study data published in the Journal of Tissue Viability highlight the lack of standardization in describing and diagnosing diaper dermatitis in newborns, infants, and young children.

Diaper dermatitis is a common condition in infants, though its diagnostic criteria are loosely defined and assessment techniques vary. To better standardize the symptoms and signs of diaper dermatitis, investigators reviewed the literature for all descriptive words used to define diaper dermatitis. From 489 eligible studies, 21 underwent full-text review. Included studies were published between 1981 and 2019. Studies were conducted in the United States (n=9), the United Kingdom (n=3), Denmark (n=1) Switzerland (n=1), New Zealand (n=1), France (n=1), the Philippines (n=1), Turkey (n=1), Hungary (n=1), Spain, (n=1), and Singapore (n=1).

Clinical signs described across studies included erythema, moisture, inflammation, and infection. Erythema was used as a single clinical descriptor in all studies and was often considered to be the first sign of diaper dermatitis. Authors of certain studies noted that erythema can be difficult to distinguish in infants with darker skin. As such, the variance in tissue consistency in relation to the surrounding area should be taken into account when screening for diaper dermatitis. Additionally, certain lesions may present with pain, manifesting as behavioral changes consistent with emotional distress.

Included studies frequently used the term “wetness” in describing causes of diaper dermatitis. While incontinence is normal for infants, skin contact with urine and feces is a contributing factor to dermatitis. Frequent diaper changes are thus essential in maintaining the skin integrity in newborns and infants. Further, infection can add to the severity of diaper dermatitis. Dermatitis with infection was described in 1 study as “confluent zones with papules pustules and satellite papules.” However, mild chafing dermatitis infrequently presents with microbiological differences.

The anatomical location of diaper dermatitis varies, with most study authors indicating that “diaper” is a redundant descriptor, particularly as the condition can arise without diaper use. Diaper dermatitis was described to be present in areas beyond those covered by the diaper, including the inner thighs and abdomen. Studies varied in their descriptions of affected anatomical regions, emphasizing the need for a clearer approach in determining the surface coverage and severity of diaper dermatitis. Across 21 studies, a total of 8 different clinical evaluation scales were used in the characterization of diaper dermatitis severity. These findings suggest considerable gaps in the clinical procedures used to diagnose and evaluate diaper dermatitis.

“The findings of the review support the development of a robust methodological tool that can bridge the gap and combine a common language of signs and symptoms to aid diagnosis of the severity of DD in clinical practice,” investigators wrote.

Reference

Dunk AM, Broom M, Fourie A, Beeckman D. Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: a scoping review. J Tissue Viability. Published online April 4, 2022. doi:10.1016/j.jtv.2022.03.003