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

Andrew N. Carr; Thomas DeWitt; Michael J. Cork; Lawrence F. Eichenfield; 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

doi:10.1111/pde.14047

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

Andrew N. Carr^*, Thomas DeWitt, Michael J. Cork, Lawrence F. Eichenfield, 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

^*Corresponding author for this work

Dermatology

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Objectives: To 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. Methods: A 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. Results: Diaper 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. Conclusions: These 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.

Original language	English (US)
Pages (from-to)	130-136
Number of pages	7
Journal	Pediatric dermatology
Volume	37
Issue number	1
DOIs	https://doi.org/10.1111/pde.14047
State	Published - Jan 1 2020

Funding

Andrew N. Carr, Susanna Brink, Yueqing Niu, and Roger D. Gibb are full‐time employees at Procter & Gamble. Mauricio Odio and Julie Ogle are retired from Procter & Gamble. All authors acknowledge that this study was wholly funded by the Procter & Gamble Company.

Keywords

diaper dermatitis
neonatal
skin barrier

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Dermatology

Access to Document

10.1111/pde.14047

Cite this

Carr, A. N., DeWitt, T., Cork, M. J., Eichenfield, L. F., Fölster-Holst, R., Hohl, D., Lane, A. T., Paller, A., Pickering, L., Taieb, A., Cui, T. Y., Xu, Z. G., Wang, X., Brink, S., Niu, Y., Ogle, J., Odio, M., & Gibb, R. D. (2020). Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior. Pediatric dermatology, 37(1), 130-136. https://doi.org/10.1111/pde.14047

@article{a85af46458b24a0daae81e1fdeaaa103,

title = "Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior",

abstract = "Objectives: To 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. Methods: A 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. Results: Diaper 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. Conclusions: These 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.",

keywords = "diaper dermatitis, neonatal, skin barrier",

author = "Carr, {Andrew N.} and Thomas DeWitt and Cork, {Michael J.} and Eichenfield, {Lawrence F.} and Regina F{\"o}lster-Holst and Daniel Hohl and Lane, {Alfred T.} and Amy Paller and Larry Pickering and Alain Taieb and Cui, {Tao Y.} and Xu, {Zi G.} and Xeumin Wang and Susanna Brink and Yeuqing Niu and Julie Ogle and Mauricio Odio and Gibb, {Roger D.}",

note = "Publisher Copyright: {\textcopyright} 2019 The Procter & Gamble Company. Pediatric Dermatology published by Wiley Periodicals, Inc.",

year = "2020",

month = jan,

day = "1",

doi = "10.1111/pde.14047",

language = "English (US)",

volume = "37",

pages = "130--136",

journal = "Pediatric dermatology",

issn = "0736-8046",

publisher = "Wiley-Blackwell",

number = "1",

}

Carr, AN, DeWitt, T, Cork, MJ, Eichenfield, LF, Fölster-Holst, R, Hohl, D, Lane, AT, Paller, A, Pickering, L, Taieb, A, Cui, TY, Xu, ZG, Wang, X, Brink, S, Niu, Y, Ogle, J, Odio, M & Gibb, RD 2020, 'Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior', Pediatric dermatology, vol. 37, no. 1, pp. 130-136. https://doi.org/10.1111/pde.14047

TY - JOUR

T1 - Diaper dermatitis prevalence and severity

T2 - Global perspective on the impact of caregiver behavior

AU - Carr, Andrew N.

AU - DeWitt, Thomas

AU - Cork, Michael J.

AU - Eichenfield, Lawrence F.

AU - Fölster-Holst, Regina

AU - Hohl, Daniel

AU - Lane, Alfred T.

AU - Paller, Amy

AU - Pickering, Larry

AU - Taieb, Alain

AU - Cui, Tao Y.

AU - Xu, Zi G.

AU - Wang, Xeumin

AU - Brink, Susanna

AU - Niu, Yeuqing

AU - Ogle, Julie

AU - Odio, Mauricio

AU - Gibb, Roger D.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objectives: To 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. Methods: A 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. Results: Diaper 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. Conclusions: These 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.

AB - Objectives: To 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. Methods: A 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. Results: Diaper 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. Conclusions: These 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.

KW - diaper dermatitis

KW - neonatal

KW - skin barrier

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AN - SCOPUS:85076153138

SN - 0736-8046

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JO - Pediatric dermatology

JF - Pediatric dermatology

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

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