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Pragmatic management of (suspected allergic) diaper dermatitis

Dear Sir, So-called diaper dermatitis covers a large spectrum of diseases, mostly comprising irritant contact dermatitis, allergic contact dermatitis, intertrigo, psoriasis, atopic dermatitis, and seborrheic dermatitis (1). We present a case of diaper dermatitis in a 4-month-old female child, diagnosed as allergic contact dermatitis on the basis of clinical features, long evolution, and the lack of response to all measures, that resolved only after the diaper had been replaced with a cotton product. Upon presentation, a large erythematous area, slightly desquamated, on the lower part of the abdomen, the sacral area and the diaper area was noted, without involvement of skin folds (Fig. 1a–c). The mother was very well trained in taking care of the child, and had never used alcohol-containing products for cleaning of the skin, but only superabsorbent disposable diapers, since the birth of the child. The child was healthy, breast-feeding, and normally developed according to her age, and was closely monitored by a paediatrician. One week after delivery, skin problems in the diaper area started in terms of erythema and slight oedema, but there was no oozing or crusting, and no maceration. Different diagnoses were made and different treatments were prescribed, including ointments, topical corticosteroids, antifungals, topical antibiotics, and calcineurin inhibitors, administered