Reasons for "diaper dermatitis" not responding to therapy:
(1) poor adherence by caregiver to treatment protocol
(2) continued presence of aggravating factor(s)
(3) wrong diagnosis - Candidiasis present
(4) wrong diagnosis - other
Treatment protocol:
(1) diaper change as soon as possible after soiling
(2) bathing twice daily while rash lasts, then daily
(3) use of a water-repellent moisturizer on the skin
Presence of aggravating factors:
(1) abrasion and frictional damage while cleaning
(2) prolonged contact of skin with urine and/or feces
(3) talc and/or chemical irritants in wipes or treatments
(4) excessive moisture with maceration of skin
(5) use of broad spectrum antibiotics
(6) allergic reaction to detergents or chemicals on the diapers
Candidiasis is relatively common in treatment-resistant diaper dermatitis. A trial of a topical anti-candidal cream should be tried together with removal of precipitating causes.
Differential diagnosis of diaper dermatitis - other infectious conditions:
(1) seborrheic dermatitis (may be associated with Streptococcus or other bacteria)
(2) congenital syphilis
(3) dermatophyte infection
(4) herpes simplex virus infection
Differential diagnosis of diaper dermatitis - noninfectious:
(1) child abuse (thermal burn from dipping in hot water)
(2) diaper psoriasis
(3) zinc deficiency
(4) biotin deficiency
(5) Langerhans cell histiocytosis
(6) milaria rubra (associated with occlusion of ducts to eccrine glands)
