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Skin care: napkin rash SKIN CARE: NAPKIN RASH
When dealing with a baby's skin problems, certain facts must be born in mind. These are that the skin of a baby is thinner, softer, and has fewer hairs and sweat glands than an adults.
There is no single cause of rash on the skin in the area broadly covered by the baby's napkin. Obviously, almost any skin disorder can manifest itself in this area. Furthermore, any of these disorders may be further aggravated by a physical environment of warmth, moisture, humidity and exposure to various infective organisms present in this area.
Contact dermatitis is one of the commonest causes of a rash in this area. This may be due to a chemical present in either the urine or faeces. Previously it was thought that ammonia formed from the breakdown of urea by various bacteria was the main cause. This, however, is probably only one of many possible chemicals involved. Occasionally detergents used in the laundering of the napkins are implicated. Even creams innocently applied by mothers either to prevent or treat a napkin rash, may be involved.
The eruption usually has the appearance of a burn. Initially it may simply be red, but then blisters and ulceration can occur. The classical distribution is on the convex surfaces in closest contact with the napkin, the creases being spared.
Seborrhoeic dermatitis is probably the second commonest cause of a rash in this area. It is an ill-understood, self-limiting condition which may also affect adults. There is usually no family history of the condition, and no nutritional or infective factor evident. Frequently there is associated 'cradle cap'. This is a mixture of grease and scale that piles up on the crown of an infant's head to form a coating resembling a cap. The exact cause is unknown, but may result from over-cautious bathing or fear of injuring the 'soft spot'. Initially this condition consists of retained vernix, the greasy film which assists the passage of the babe through the birth canal. When this vernix persists as a dry crust on the scalp, it is termed cradle cap.
Seborrhoeic dermatitis usually commences in the napkin area between the ages of three months and one year. The symptoms are usually fedness with scaling. The creases and folds are involved, unlike with contact dermatitis. Frequently other creases, such as the armpits and under the chin subsequently become involved. In severe cases other areas of the trunk can also be affected. The baby is usually quite well, and does not scratch the rash. "
Infantile eczema usually occurs in infants of parents with the atopic tendency to either eczema, hay fever, hives or asthma. The rash usually appears between the ages of two to three months. It is often first manifest on the cheeks and forehead, but not necessarily. The rash is invariably red, lumpy and involves the creases. It is always itchy, unlike the other rashes.
Psoriasis may occur solely in the napkin area of infants. The features are similar to psoriasis in other areas. It is thought to be induced by external factors such as monilia, in a genetically predisposed infant. It develops very rapidly, and rarely confines itself solely to the napkin area. Usually it clears quickly with appropriate treatment. Relapses are exceptional, and the long-term prognosis is fair. It is estimated that only between 10-20 per cent of these infants will develop psoriasis in later life.
Thrush, sometimes known as monilia, is a frequent cause of and contributing factor to napkin rash. This is a yeast infection caused by the fungus Candida albicans. It can occur at any age. The appearances of a bright red rash, not necessarily symmetrical, with small pustules is very suggestive of thrush. Frequently the area about the tip of the penis is very red, and small, bright red satellite spots appear elsewhere. The area may weep, particularly in the creases. The source of infection may be bowel, particularly after a course of antibiotics. Alternatively, the infection may originate from mothers with vaginal thrush.
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