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Chapter 2 Index
A. Evaluation by system:
1. General
2. HEENT
3. Cardiopulmonary
4. GI
5. GU
6. Orthopedics
7. Neurological
8. Skin
--The Evaluation of a
Rash: Is it Allergic?
--Common Viral Rashes of Childhood
--Parvovirus B19 |
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Diagnosis and Treatment of Diaper Rash
1. Diaper Rash: or “Irritant Contact Dermatitis”: does not
necessarily need Nystatin
- results from overhydration of the skin, friction, maceration,
contact with feces and/or urine, reaction to medications, type of diaper
- findings on physical exam
- red, scaly, fissured and eroded; patchy or confluent
- if secondarily infected: impetiginous or candidal
- basic treatment:
- frequent changes with cleansing: do not recommend leaving diapers
off.
- discontinue fruits and juices, use diaper wipes sparingly, and
avoid fabric softeners, avoid dusting powders routinely, was with mild
soap - Dove; pat dry or use a hair dryer to blow dry.
- topical steroids - warnings may be overstated about recurrent
use.
Treatment of the Resistant Diaper Rash: Remember to ask which kind of
diaper is being used!
Associated problems that might give clues to resistant diaper rash other
than hygiene:
- ****atopic dermatitis - commonly overlooked
reason for resistant rash must treat this as would treat atopic
dermatitis.
- candida: often have history of recent
antibiotics, but also see if any history of atopic derm or seborrhea.
- PE: red, confluent plaque with serpiginous border often involving the perianal skin, inguinal
folds,
- RX: made worse by cornstarch (usually) nystatin, miconazole,
clotrimazole, ketoconazole 3-4 X/day gentian violet also an
alternative -but can be irritative may need po meds as well some use a combination of
steroid and nystatin: if atopic -
Mycolog II contains no
neomycin - less sensitizingalso use thick paste of
zinc oxide or vaseline
- psoriasis: may be only area involved in
pediatrics: look for papulosquamous disorder characterized by white scaly
patches. Rx: tar
- impetigo: just as in atopic derm, can be a
subtle diagnosis
- rare illnesses: acrodermatitis, histiocytosis
X, tinea, and seborrhea
Nonprescription Diaper Rash Ointments and Their Ingredients:
- Desitin Ointment: Zinc Oxide (40%), Cod Liver Oil in a
petrolatum-lanolin base - can prevent as well as treat diaper rash.
- Desitin Cornstarch Baby Powder: contains zinc oxide with topical
starch: Keep powder away from baby’s face.
- A and D ointment: Cod Liver Oil, white petrolatum, lanolin, and zinc
oxide
- Caldesene powder and ointment: ointment: petrolatum and zinc oxide
with cod liver oil, lanolin; talc in powder
- Balmex: zinc oxide in peruvian balsam… same as Flanders Ointment (per
Dr. Flanders)
Reviewed 10/2001
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