Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior

• DOI: 10.1111/pde.14047
• Publication Date: 2019-12-03T02:07:01Z
• Authors: Andrew N. Carr; Thomas DeWitt; Michael J. Cork; Lawrence F. Eiche...; Regina Fölster‐Holst; Daniel Hohl; Alfred T. Lane; Amy Paller; Larry Pickering; Alain Taieb; Tao Y. Cui; Zi G. Xu; Xeumin Wang; Susanna Brink; Yeuqing Niu; Julie Ogle; Mauricio Odio; Roger D. Gibb
• Keywords: Male; China; 610; neonatal; Paediatrics and Reproductive Medicine; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Germany; Surveys and Questionnaires; Prevalence; Humans; skin barrier; Diapers; Skin; Pediatric; Dermatology & Venereal Diseases; Diapers, Infant; Infant; Original Articles; Hydrogen-Ion Concentration; United States; 3. Good health; Cross-Sectional Studies; Caregivers; Diaper Rash; Infant Care; Buttocks; Female; diaper dermatitis; Buttocks; Caregivers/statistics & numerical data; China/epidemiology; Cross-Sectional Studies; Diaper Rash/epidemiology; Diapers, Infant/statistics & numerical data; Female; Germany/epidemiology; Humans; Hydrogen-Ion Concentration; Infant; Infant Care; Male; Prevalence; Skin; Surveys and Questionnaires; United States/epidemiology; diaper dermatitis; neonatal; skin barrier

AbstractObjectivesTo compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.MethodsA cross‐sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet‐training habits, exclusively diaper‐wearing infants were recruited between ages 2‐8 months in China and 2‐18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.ResultsDiaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2‐8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine‐only diaper changes, and Chinese infants spent the least time in an overnight diaper.ConclusionsThese data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.