Mrs. Smith brings her 6-month-old infant with a 2-week history of diaper dermatitis to your office. What topical steroid do you prescribe? Would you recommend any other topical therapy?

For the diaper area, use only a low-potency topical steroid applied three times daily for no more than 7 to 10 days. The diaper area has air-tight occlusion, increasing the risk of local and systemic side effects (see Table 50-2). Any diaper dermatitis that has persisted for more than 3 days should be treated for secondary candidal infection. Avoid use of combination steroid/antifungal preparations.

Granuloma gluteale is a condition characterized by persistent reddish-purple nodules and plaques in the diaper area. Although the exact etiology of granuloma gluteale is debated, most agree that the inappropriate use of topical steroids and secondary candidiasis play important roles.

Table 50-2. Topical Steroid Side Effects
	LOCAL CUTANEOUS SIDE EFFECTS		SYSTEMIC SIDE EFFECTS
	Acne vulgaris, acne rosacea, periorificial dermatitis Atypical presentation of skin diseases (i.e., tinea incognito) Burning, stinging, erythema, peeling Contact dermatitis Delayed wound healing Dermal atrophy with skin “dents/potholes” Epidermal atrophy with telangiectasia and purpura Exacerbation of psoriasis with rebound phenomenon Exacerbation of skin infections and infestations Folliculitis Granuloma gluteal Hirsutism Hypopigmentation Skin blanching Steroid addiction syndrome Striae Susceptibility to skin infections		Cushing’s syndrome Fluid retention Growth retardation, failure to thrive Hypothalamic-pituitary-adrenal (HPA) axis suppression Hypertension Increased blood sugar Ocular hypertension, glaucoma, cataracts