Work up for Langerhans cell histiocytosis:
Is there concern for bacterial infection? Bullous impetigo with fluid-filled blisters or blister remnants? Folliculitis with pustules and erythema surrounding a hair follicle? Perianal erythema concerning for possible streptococci or S. aureus?
Is there concern for acrodermatitis enteropathica? Scaly, well demarcated erythema. Can be seen when infants are weaned from breast milk to cow’s milk formula.
If conservative treatment with appropriate diaper care has been attempted for at least 72 hours and diaper dermatitis does not fit any of the above descriptions, consider referral to Pediatric Dermatology.
Is there concern for seborrheic dermatitis? Erythematous, greasy, well demarcated patches and plaques. Can also be found on the scalp (“cradle cap”), face, ears, and neck.
Has the family been following best diaper care practices including applying barrier cream for >72 hours?
Is there concern for candidal dermatitis? “Beefy” red rash involving inguinal creases, often with scaling at the margin and satellite papules or pustules? May have recent history of antibiotic use or concurrent oral thrush.
Is there concern for Langerhans cell histiocytosis? Scaly, erythematous papules and plaques that occur on the scalp, posterior ear folds, neck folds, and inguinal folds. Often confused for seborrheic dermatitis.
Treat seborrheic dermatitis:
History and Physical, including:
Best Diaper Care Practices:
Diagnose and treat acrodermatitis enteropathica:
Is there concern for Jacquet’s erosive diaper dermatitis? Well-defined shallow ulcers or ulcerated nodules.
Treat irritant diaper dermatitis:
Treat candidal diaper dermatitis:
Treat irritant diaper dermatitis:
Work up and treat suspected bacterial diaper dermatitis: