Diaper Area, Buttocks, and Gluteal Cleft

Diaper Area, Buttocks, and Gluteal Cleft


The unique environment of the diaper area is predisposed to the friction of repeated movement, chafing, local heat, and maceration from retained moisture, all of which serve to provide an excellent environment for potential irritant, fungal, as well as bacterial complications.

Being sun-protected, most eruptions that arise on the buttocks are inflammatory rather than neoplastic in nature. The relatively rare, but increasing incidence, of cutaneous T-cell lymphoma (mycosis fungoides) is an exception.

Dermatoses that occur in the perineal region, the buttocks, and the gluteal cleft are often associated with lesions on other parts of the body. Examples include folliculitis, furunculosis, psoriasis, eczema, and tinea corporis. There are also disorders that are characteristically seen perianally such as anogenital warts, condyloma lata of secondary syphilis, and external hemorrhoids. Perianal bacterial dermatitis and anogenital warts are problems that may appear in the pediatric age group.


Infants and Toddlers

Diaper Rash

Distinguishing Features

  • The dermatitis presents as erythematous, shiny, moist patches on the convex surfaces of the buttocks, the vulva, perineal area, proximal thighs, and lower abdomen (Fig. 17-1)

  • In contrast to infantile atopic dermatitis (see below), lesions typically spare the genitocrural folds because such areas do not come into direct contact with the diaper

  • The eruption may conform to, and be limited to, the diaper area (Fig. 17-2), or it may be more widespread

  • When Candida albicans complicates diaper rash, the infection preferentially affects the skin folds, with bright red erythema and satellite papules and pustules (Fig. 17-3)

  • With neglect, painful erosions or ulcerations can develop

Infantile Atopic Dermatitis

Distinguishing Features

  • Lesions typically appear in the inguinal creases; the diaper area is remarkably spared (Fig. 17-4)

  • “Cradle cap” is often present (see also Figs. 2-1 and 2-2)

  • There may be evidence of atopic dermatitis elsewhere on the body

  • Lesions are often pruritic

Bullous Impetigo (See Cheeks)

Distinguishing Features

  • Starts with small vesicles that enlarge to 1-2 cm superficial bullae

  • Later bullae collapse leaving a “collarette of scale” (Fig. 17-5)


Tinea Corporis

Distinguishing Features

  • Distribution of lesions is usually asymmetrical

  • Lesions of tinea corporis are generally annular, with peripheral enlargement and central clearing; however, lesions on the buttocks have a propensity to be more blended into one or more confluent scaly patches, and, therefore, the entire lesion tends to be scaly (Fig. 17-6)

  • Often asymptomatic


Distinguishing Features

  • Well-demarcated, symmetric erythematous plaques with characteristic overlying white or silvery (micaceous) scale (Fig. 17-7)

Jan 8, 2023 | Posted by in Dermatology | Comments Off on Diaper Area, Buttocks, and Gluteal Cleft

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