Diaper dermatitis is a form of irritant contact dermatitis that is common in the pediatric population. It can present as early as 3 weeks of age or as late as 2 years old.

Diaper dermatitis presents as erythema and mild scaling on the convex surfaces of the medial thigh, lower abdomen, and buttock, classically sparing the inguinal folds where the skin is not in contact with irritants (Fig. 11-1). The irritants, typically urine and feces, create moisture and increased pH which compromise skin integrity. The reduction in skin barrier function further increases susceptibility to infections to microorganisms such as Candida albicans. These organisms further increase the clinical severity of diaper dermatitis.

Many other dermatoses can affect the diaper area and need to be excluded. Skin cultures or KOH preparation can be performed to identify C. albicans, which is the most common infectious etiology of diaper dermatitis. A biopsy is usually not necessary, but can be performed to rule out other causes such as psoriasis, lichen sclerosis, and Langerhans cell histiocytosis. Patch testing may also be performed if allergic contact dermatitis is suspected. Common causes of allergic contact dermatitis include chemicals contained in baby wipes and diapers themselves, which tend to present in a pattern that resembles a cowboy’s holster due to elastic bands coming into contact with the skin. If zinc deficiency is suspected, a zinc level should be obtained from a blood sample (Tables 11-1 and 11-2).