| Table 2-2 Differential Diagnosis for Diaper Dermatitis |
| | Entity | | Clinical Findings |
| | Candidal Dermatitis | | Bright red patches with pustules and satellite papules, ± intertriginous involvement (including scrotum), ± thrush |
| | Irritant Dermatitis | | Poorly demarcated erythematous plaques, spares inguinal folds |
| | Seborrheic Dermatitis | | Typical salmon-covered scaly patches and plaques involving the scalp, groin, and other intertriginous areas |
| | Psoriasis | | Sharply demarcated bright pink to red plaques involving inguinal creases, minimal scale; most common psoriatic presentation in infants |
| | Allergic Contact Dermatitis | | Rare in infants, ± related to topical preparations or foods |
| | Atopic Dermatitis | | Increased incidence of diaper dermatitis in atopic patients |
| | Miliaria | | Clear vesicles or erythematous papules/pustules due to blocked
eccrine ducts from heat or humidity in diaper area |
| | Granuloma Gluteale Infantum | | Red to violaceous granulomatous nodules over the vulva, perianal area, buttocks, ± scrotum; due to irritation, occlusion, candidal infection |
| | Perianal Pseudoverrucous Nodules | | Erythematous nodules and papules in children with fecal incontinence |
| | Acrodermatitis Enteropathica | | Erythematous crusted patches/plaques with flaccid bullae in perineal, periorificial, and distal extremities; due to ↓ zinc level (also ↓ alkaline phosphatase as zinc-dependent); may occur in following settings: |
| | | | - Premature infants (poor absorption and ↑ requirement of zinc) when weaned off breast milk (which has adequate zinc level)
- Inherited form (AR) manifests when weaned off breast milk
- Healthy infants if low zinc level in maternal milk
- Acquired form if malabsorption or inadequate nutrition
|
| | Cystic Fibrosis | | Resembles acrodermatitis enteropathica, also due to zinc deficiency ± pedal edema, failure to thrive, infections and malabsorption |
| | Multiple Carboxylase Deficiency | | Both resemble acrodermatitis enteropathica (periorificial dermatitis); treatment for both forms (listed below) is biotin |
| | Biotin Deficiency | | - Neonatal form: AR, holocarboxylase synthetase deficiency, ± erythroderma with alopecia, fatal if not treated
- Juvenile form: biotinidase deficiency, ± seizures, alopecia, hearing loss, developmental delay
|
| | Langerhans Cell Histiocytosis | | Yellow-brown crusted papules with purpura in seborrheic distribution; ± systemic involvement; Langerhans cells (CD1a +, S100+) |
| | Kawasaki Disease | | Tender erythema in perineal area which later desquamates |
| | Perianal Strep | | Bright red, well-demarcated perianal erythema and involving creases |
| | Bullous Impetigo | | Honey-colored crusts and flaccid bullae |
| | Scabies | | Erythematous nodules involving diaper area, ± genitalia |
| | Congenital Syphilis | | Reddish-brown papulosquamous eruption, may be erosive or bullous |
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