Nappy dermatitis is one of the common dermatoses of infancy and early childhood. It is characterised by skin lesions and general symptoms, which in the vast majority of cases allow the diagnosis to be established. The general symptoms observed and reported by parents include the child's restlessness, irritability and excessive crying, which increase especially during nappy changes, washing or wiping of the nappy area. Nappy dermatitis is rarely accompanied by pruritus. In cases complicated by local and generalised bacterial or fungal infection, fever and deterioration of the general condition may occur [5,10,14,15].
The initial stage of psoriasis vulgaris may present as treatment-resistant, persistent for months or recurrent inflammatory lesions in the nappy area, mimicking nappy dermatitis, particularly in infants and young children prone to atopy. The general condition of children is good and the skin lesions are generally not accompanied by general symptoms. Before the characteristic vivid red papules covered with silvery scales in areas typical of psoriasis appear, making a correct diagnosis is difficult. A family history of psoriasis and atopy is important, and sometimes a histopathological examination of a skin slice is necessary to make a correct diagnosis [3,4,17].
Yeast dermatitis of the nappy area can occur as a primary infection or as a secondary infection that is a complication of inflammation caused by other factors. It differs from nappy rash dermatitis by the presence of satellite lesions, red papules and pustules on the periphery of the erythematous lesions. Yeast infection of the nappy area is often accompanied by oral thrush, nailve inflammation and inflammatory lesions of other excoriation areas such as the neck, armpits. In difficult cases, a mycological examination can be performed to confirm the presence of fungi [3,5,6,13,14,15,16,17].
Nappy dermatitis can sometimes be complicated by secondary bacillary infection, especially staphylococcal or streptococcal infection. The presence of blisters and pustules with cracked epidermis, the formation of erosions covered with honey-yellow scabs should draw attention to this cause of dermatitis. Positive microbiological cultures confirm the diagnosis [3,5,13,14,15,16,17].
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photo: Sudocrem
It is worth adding that in most cases nappy rash is easy to diagnose and is usually a benign and treatable condition, but it can sometimes be a symptom of rare infections, metabolic diseases, malabsorption syndromes, nutritional deficiencies, immune disorders, tumours or child abuse syndrome. Rarer causes of dermatitis in the nappy area should always be considered in the presence of persistently recurrent skin lesions that do not respond to standard management and the appearance of symptoms atypical of nappy dermatitis [3,5,9,15].
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