Emerging Links between Microbiome Composition and Skin Immunology in Diaper Dermatitis: A Narrative Review

Diaper dermatitis is a common type of irritant contact dermatitis occurring in infants and toddlers. Its occurrence is triggered by an unfavorable environment under the diaper, damage to skin integrity by fecal enzyme degradation, overhydration and disruption of the lipid bilayer structure facilitating the entry of irritants and microorganisms. In diaper dermatitis development, the central proinflammatory cytokines are IL-1α, IL-8 and TNF-α. The initial release of IL-1α and TNF-α starts a further cascade of pro-inflammatory chemo- and cytokines, resulting in inflammation and erythema of the skin. A recently recognized factor in diaper dermatitis is the composition of the skin microbiome; common pathogenic strains Candida albicans and Staphylococcus aureus are associated with skin irritation. The resulting impaired microbiome composition produces a local inflammatory response and may thus worsen the initial dermatitis clinical presentation and subsequent healing. Introduction of probiotics is an attractive treatment for microbiome modulation, which has shown success in other skin conditions in adults and children. Probiotics are thought to work as a protective shield against irritants, maintain low skin pH, secrete beneficial metabolites, and block pathogen invasion. There is preliminary evidence that certain probiotics given orally or topically could be used as a gentle intervention in diaper dermatitis.

Comparative evaluation of the clinical effects of high Air-Through soft diaper and standard diaper in Indian babies with diaper rash

The incidence of diaper dermatitis (rash) in India is reported to be in the range of four to thirty-five per cent in children up to 2 years of age. To evaluate the clinical effect of using High Air-Through Soft Diaper and babies’ favourite diaper (Standard diaper) on Indian babies’ skin. This was a single-blinded, randomized, controlled, cross-over study. Eligible babies were randomized in two treatment groups. Babies in Group A used High Air-Through Soft Diaper for the first two weeks and then used standard diaper for the next 2 weeks. Babies in Group B used a standard diaper for the first two weeks and then used a High Air-Through Soft Diaper for the next 2 weeks. The study was completed with 105 babies. Theevaluation of the skin using the scoring system and photographs for representative purposes. At baseline, the mean total diaper rash scores were comparable in both Group A and Group B viz. 3.04 ± 1.00 and 3.30 ± 1.04 respectively and the difference was not statistically significant (p = 0.195). After 2 weeks, the mean total diaper rash score increased significantly from the baseline in both Group A and Group B (5.05 ± 1.97; p = 0.001 and 6.16 ± 2.22, p = 0.001 respectively); the rise in the mean total diaper rash score was significantly more in Group B than that in Group A (p = 0.045). After 4 weeks, a significant increase in the mean total diaper rash score (1.31 ± 2.69; p =0.001) was observed from what it was at 2 weeks in the Group A and there was an insignificant decrease in the mean total diaper rash score (-0.52 ± 2.54; p =0.153) in Group B from what it was at 2 weeks; the change in the mean total diaper rash score was significantly more in Group A than that in Group B (P = 0.001). Both High Air-Through Soft Diaper and standard diaper in babies caused a significant increase in mean total diaper rash score. However, the extent and the degree of rash induced with the use of High Air-Through Soft Diaper was significantly less than that during the usage of the standard diaper. Thus, High Air-Through Soft Diaper due to technologies used in it appears to be superior to the standard diaper in reducing the mean total diaper rash score.

Prevalence and Risk Factor of Diaper Dermatitis among Saudi Children

Background: Diaper dermatitis (DD), commonly known as diaper rash is an inflammatory disease of the skin of diaper wearing area. It is usually seen in children belowss 24 months and is not considered by doctors as a serious problem. However, it often causes discomfort and apprehension among parents. Methods: A cross-sectional study performed through patient questionnaires. A total of 1344 patients were included in the study. A pilot was done to test the validity and reliability of developed questionnaire and also to calculate the minimum sample size for our study. By considering the values derived from the pilot study done among 50 parents of children aged 1-24 months who used diapers. A standardized methodology was followed in the validation of this questionnaire that included focus group discussion, expert evaluation, pilot study, reliability and validity assessment etc. Three experts in the field of medicine (dermatologist, pediatrician, and internist) and one biostatistician were involved in the validation of our questionnaire. Result: In our study majority of the participants were females (87.3%), and 55.3% belonged to the 20-25 years age group. The fixed orthodontic related history showed 59.8% had undergone the treatment for 1 to 3 years and 31.6% of the participants reported that they had removed the fixed braces for more than five years. Among these participants, 89.5% (n=34) reported that the fascia (space) closed between the upper frontal teeth after Frenectomy, and 65.8% (n=25) agreed that spaced between the two upper front teeth still closed after removing the retainer. Conclusion: The reported prevalence of diaper dermatitis in our study was found to more in the Kingdom of Saudi Arabia. There is huge anxiety created among parents, and this would result in increased pediatric consultations.

A clinical study of dermatotses in neonates in Silchar medical college

According to WHO a neonate, is a child under 28 days of age. The neonatal skin changes show a wide geographic and ethnic variation. It is important to know the pattern of dermatoses prevalent among Indian children during the neonatal period. The current study was conducted to study the prevalence of neonatal dermatoses in southern Assam and to study relationship of neonatal dermatoses with maturity and birth weight of neonates.150 neonates who developed cutaneous lesions over a period of one year were examined. Proportion of each dermatoses and prevalence ratio were calculated using relevant formulae. Out of the 150 neonates, 66 % neonates had transient physiological changes, 11.33% had congenital disorders and genodermatoses, 4.67% had iatrogenic complications, 30% had acquired skin diseases, 8% had neonatal infections and 2% had other miscellaneous diseases. The five most common dermatoses overall were diaper dermatitis (17.33%), miliaria (14%), erythema toxicum neonatorum (13.33%), infantile seborrheic dermatitis (12.67%), sebaceous gland hyperplasia (6%) and Mongolian spot (6%). Low birth weight babies had predilection for vernix caseosa, sucking blisters, candidiasis, miniature puberty, caput succedaneum, cephalohematoma, physiological jaundice, infantile acropustulosis, salmon patch, Epstein’s pearls/ Bohn's nodules, miliaria, sebaceous gland hyperplasia, neonatal acne, Mongolian spot, bullous impetigo, erythroderma Preterm neonates had predilection for vernix caseosa, sucking blisters, miniature puberty, candidiasis, Mongolian spot, caput succedaneum, cephalohematoma, erythroderma, miliaria, Epstein’s pearls/ Bohn's nodules and a positive association was seen between post-term neonates and physiological desquamation, diaper dermatitis. Neonatal psoriasis and neonatal dermatophyte infection were the unusual findings which we found in our study.

Isolation and Identification of Candida Species and Some Superficial Mycosis Associated with Diaper Dermatitis in Erbil City

Diaper dermatitis (DD) is the most common cutaneous diagnosis in infancy that affects almost every child during the early months of their life time; most cases are associated with the yeast colonization of Candida or DD candidiasis and some dermatophytes. It is an irritating and inflammatory acute dermatitis in the perineal and perianal areas resulting from the occlusion and irritation caused by diapers. The study aimed to assess the association between Candida species and some dermatophytes in infants with napkin dermatitis and determine the prevalence of DD in relation with yeast (Candida) colonization and identify common Candida spp. which is responsible for Candida (fungal) DD among infants. Data from 210 infants aged between (0 and 18) months are collected from January to August 2018 in Raparin Hospital in Erbil City. The cases include 113 (53.80%) male infants and 97 (46.19%) female infants and diagnosed with DD. Results of 210 infant with diaper rash participated in this study. 188 (89.52%) were positive for Candida spp. and Dermatophytes (molds). From the total yeast number, Candida albicans was the most predominant species accounting 128 (84.21%), while 24 (15.78%) were non-albicans and dermatophyte molds among which Malassezias spp that accounted 26 (13.83%) and 10 (5.32%), respectively. The percentage of misdiagnosed cases was 9 (4.28%). Infants at age group 6–12 months showed high frequency with diaper rash 127 (60.47%). The prevalence of DD is higher in urban 120 (57.14%) than rural area 90 (42.85%). Furthermore, high prevalence DD found in hot season than colds was 121 (64.36%) and 67 (35.63%), respectively. In conclusion, I found that there are high association between DD with Candida spp. and dermatophytes and Candida albicans is a common invader of all types of napkin eruption.

Fox sign in a case of terminal stage pancreatic cancer and suggestions for diagnosis

Skin signs in acute pancreatitis are well-known and frequently discussed manifestations accompanied by unfavorable prognoses although they may rarely appear in clinical and forensic medicine. In 2018, the district attorney’s office ordered a forensic autopsy for a 74-year-old man with terminal stage pancreatic cancer. The autopsy was ordered based on accusations of the deceased’s widow regarding alleged medical malpractice and poor hospital care. The widow filed a grievance about multiple unsuccessful attempts to draw blood from her husband in addition to a diaper dermatitis at the right groin. An autopsy and additional histological examinations were performed. After considering all findings, the diaper dermatitis was eventually assumed to be a Fox sign caused by acute pancreatitis, and the allegations of medical malpractice were refuted. This case led us to identify another case with suspected cutaneous manifestations in pancreatic disease. We performed immunohistochemical staining on those two cases and six control cases to examine whether there was detectable presence of pancreatic lipase and trypsin in the skin discolorations and whether it could be used as a feasible method to verify skin signs associated with pancreatitis. Based on our findings, a minor disseminated lipase and trypsin staining should be considered regular and is therefore not conclusive of a skin sign associated with pancreatitis. Moreover, trypsin does not seem to be as suitable as lipase for this suggested immunohistochemical method. Nevertheless, this method might be a useful addition for determining the origin of skin discoloration and verifying skin signs associated with pancreatitis.

Anti-Inflammatory and Restorative Effects of Olives in Topical Application

Background and Objective. Olive oil is used as a traditional treatment for wounds, sores, and infections, and the effectiveness of topical use and absence of side effects have been reported in various clinical trials. The present study is an overview of the anti-inflammatory properties of olive oil in its topical application for various skin diseases and wounds. Methods. A literature search was conducted (1990–2021) in Medline, Embase, CINAHL, Google Scholar, Science Direct, SID, IranDoc, and Magiran databases. From the 102 reviewed articles, 17 articles were selected to be included in the current article. Results. Various forms of olive have long been used to accelerate the healing of various wounds and skin damage such as diabetic foot ulcers, atopic dermatitis, diaper dermatitis, episiotomy wound, and nipple ulcer but there are still no credible documents or articles that provide reliable evidence of topical use. Conclusion. According to the information obtained from the articles reviewed, olive oil appears to be an effective, safe, and available treatment. This study suggests that olive oil is an alternative remedy to minimize the frequent use of chemical-based treatments. More research may be beneficial to reach certainty in terms of curative properties of olive oil in similar or different injuries in different populations.