Pigmented and hyperkeratotic napkin dermatitis: a liquid detergent irritant dermatitis.

BACKGROUND: Napkin or diaper dermatitis (DD) is an inflammatory cutaneous eruption limited to the diaper area and common in the first 2 years of life. A number of clinical variants of DD have been identified.

OBJECTIVE: We report a new variant of DD characterized by papyraceous skin, brownish discoloration and predilection for the depth of folds.

METHODS: 15 infants and toddlers affected by this peculiar type of DD were evaluated regarding duration, localization, morphology and evolution of their dermatosis.

RESULTS: This variant of DD was mainly confined to the depth of inguinal and gluteal folds and invariably associated with severe xerosis with papyraceous and glazed skin. The patients were healthy and asymptomatic and all laboratory investigations performed were normal. All patients were frequently changed and thoroughly washed with synthetic detergents with acid pH. DD improved rapidly with reduced frequency of washing and discontinuation of liquid detergents.

CONCLUSIONS: We conclude that this condition is a type of irritant contact dermatitis from excessive use of lipid acid detergents.