A 7-month-old girl is brought to the office due to a rash. The mother states, "The rash began 3 days ago on her buttocks and has spread to her genitalia. I have been changing her diapers constantly and tried different brands of baby wipes, but the rash is getting worse." She reports that the child has been tugging at her diaper and has been "a little fussier than normal" but otherwise playful. The patient has been drinking her usual 4 bottles of formula daily, and her sleep pattern has not changed. A week ago, the child had a mild diarrheal illness that has since resolved. She has had no fever, runny nose, or cough. The patient was born full term without complications and has no chronic medical conditions. Family history is significant for allergic rhinitis in her mother and asthma in her 4-year-old sister. All vaccinations are up to date. Temperature is 36.7 C (98.1 F), and all other vital signs are normal. Physical examination reveals an active child in no distress. The rash is shown in the image below. A similar rash is present over the labia but not over the inguinal folds or thigh creases. Which of the following is the best treatment for this patient?

Question

A 7-month-old girl is brought to the office due to a rash.  The mother states, "The rash began 3 days ago on her buttocks and has spread to her genitalia.  I have been changing her diapers constantly and tried different brands of baby wipes, but the rash is getting worse."  She reports that the child has been tugging at her diaper and has been "a little fussier than normal" but otherwise playful.  The patient has been drinking her usual 4 bottles of formula daily, and her sleep pattern has not changed.  A week ago, the child had a mild diarrheal illness that has since resolved.  She has had no fever, runny nose, or cough.  The patient was born full term without complications and has no chronic medical conditions.  Family history is significant for allergic rhinitis in her mother and asthma in her 4-year-old sister.  All vaccinations are up to date.  Temperature is 36.7 C (98.1 F), and all other vital signs are normal.  Physical examination reveals an active child in no distress.  The rash is shown in the image below.  A similar rash is present over the labia but not over the inguinal folds or thigh creases.  Which of the following is the best treatment for this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_be73_9912_8f63_e3eae3817e93_MD0005_00 Irritant, or contact, diaper dermatitis is due to several factors, including overhydration, friction, maceration, and prolonged contact with excretions. Physical examination demonstrates erythema in the diaper region, sparing the skinfolds that are typically not exposed to the contributing factors. The appearance of the rash after an episode of diarrhea is very characteristic. erythema in the diaper region Diaper dermatitis is diagnosed clinically. Management focuses on keeping the diaper area as dry as possible. Measures include frequent diaper changes, avoidance of excessively tight-fitting diapers, exposure of the skin to air, and application of barrier creams (eg, zinc oxide, petrolatum). Gentle cleansing with soap and water or alcohol- and fragrance-free wipes are also recommended. A low-potency corticosteroid ointment can be considered if the rash persists. High-potency corticosteroids (Choice B) should never be used in the diaper area due to the risk of systemic absorption and adrenal suppression. (Choice A) Bacterial superinfection can occur in diaper dermatitis but presents with pustular drainage or honey-crusted lesions. Topical antibiotics (eg, bacitracin, mupirocin) are first-line treatment. (Choices C and D) Nystatin is a topical antifungal agent used in the treatment of candidal diaper dermatitis, which presents with "beefy"-red plaques, satellite lesions, and involvement of skinfolds. Miconazole is also used in the treatment of candidal diaper dermatitis, but the powder formulation of any diaper dermatitis therapy should be avoided due to aspiration risk. This patient's rash spares the skinfolds. Educational objective: Irritant diaper dermatitis presents with erythema that spares the skinfolds. Management includes frequent diaper changes, avoidance of excessively tight-fitting diapers, exposure of the skin to air, and application of barrier creams (eg, zinc oxide, petrolatum). References: Diaper dermatitis: a review and update. (http://www.ncbi.nlm.nih.gov/pubmed/22790100) Prevention, treatment and parent education for diaper dermatitis. (http://www.ncbi.nlm.nih.gov/pubmed/26264797)

A 7-Month-Old Girl Is Brought to the Office Due to a Rash