The skin is the largest organ of the human body and has secretory, metabolic and perceptual functions, as well as a protective function against factors of the external world [9]. It is a complex and dynamic organ, comprising many layers and appendages of the skin. The epidermis is the outermost part that protects against the loss of body fluids and the entry of toxins, microorganisms, irritants into the body. It is the first line of immune response and also protects against the harmful effects of ultraviolet radiation.
The underlying dermis is a mechanical barrier and a place for hair follicles and sebaceous glands [3,9]. The skin structure of the newborn and young child differs from that of an adult. It is thinner, flaccid, has fewer collagen and elastin fibres, a more extensive network of blood vessels, and the sebaceous and sweat glands are not yet fully functioning [9]. These anatomical and functional differences make a young child's skin very sensitive, prone to irritation, prone to dryness, more permeable to external factors, less able to defend itself against microorganisms and, as a result, at greater risk of damage and the development of acute or chronic inflammatory reactions [9]. Depending on the aetiological factor and pathomechanism, there are three basic categories: contact, infectious and allergic dermatitis [3,10,14].
Contact dermatitis caused by irritation, or nappy dermatitis, is one of the most common conditions in infants and young children. It is an inflammatory condition caused by skin contact with irritants: chemical (ammonia, urease, acids contained in urine and faeces), physical (moisture, elevated temperature), mechanical (tight, rubbing nappies, underpants), often in combination with inadequate care [2,3,5,6,9,10,12,13]. The localisation of the lesions corresponds to the areas of nappy-skin adhesion and usually occupies the anal area, genitals, buttocks, lower lower abdomen, inner thigh surfaces with vacant areas in the groin. The severity of the lesions depends on the concentration of the irritant and the duration of exposure. The nappy area is particularly prone to the occurrence of inflammatory lesions due to the presence in these areas of faecal residues, urine, which, combined with the widespread use of nappies acting as an occlusive dressing, increases the irritant effect of the substances mentioned [3,5,6,7,10,12,13,14]. Ammonia formed from urine under the influence of bacteria was considered the primary aetiological factor. Nowadays, it is emphasised that the main element damaging the skin continuity is faecal residues with the acids they contain, and once damaged, the skin becomes more susceptible to other irritants such as detergents in laundry detergents, allergens contained in nappies or children's cosmetics.
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photo: Sudocrem
Hygiene negligence, tight and too infrequent nappy changes and infections play a major role [3,7,12]. Inflammation often occurs in overheated children, in warm seasons, with inadequate care of the skin in the nappy area [9]. Diarrhoea caused by infection or as a complication of antibiotic therapy often causes acute inflammation resistant to treatment. Allergic contact dermatitis results from an immune response to allergens present in nappies, cosmetics, cleansers and affects children with atopy [10,14].
