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Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior
Andrew N Carr1, Thomas DeWitt2, Michael J Cork3
1Procter & Gamble, Cincinnati, OH, USA.
Insights
Diaper dermatitis (DD) is less common in Chinese infants due to specific caregiver practices like prophylactic product use and efficient diaper changes. These habits promote healthier skin barriers and lower pH levels.
Area of Science:
- Pediatrics
- Dermatology
- Public Health
Background:
- Diaper dermatitis (DD) is a common skin condition in infants and toddlers.
- Understanding geographical variations in DD prevalence and associated caregiver practices is crucial for prevention strategies.
Purpose of the Study:
- To compare the prevalence and severity of diaper dermatitis (DD) in infants across China, the USA, and Germany.
- To investigate the relationship between diapered skin condition (pH, TEWL, RH) and caregiver practices in different countries.
Main Methods:
- A cross-sectional study involving 1791 infants across China, USA, and Germany.
- Measurement of diaper dermatitis, skin pH, transepidermal water loss (TEWL), and relative humidity (RH).
- Caregiver habits, including hygiene and product usage, were assessed via questionnaires.
Main Results:
- Diaper dermatitis prevalence was significantly lower in Chinese infants compared to those in Germany and the USA.
- Lower DD in China correlated with lower skin pH, reduced TEWL, and decreased RH in the diapered area.
- Chinese caregivers reported higher use of prophylactic topical products, more thorough cleaning, and less time in overnight diapers.
Conclusions:
- Caregiver behaviors, such as prophylactic topical product use and efficient diaper hygiene, are associated with reduced diaper dermatitis.
- These practices contribute to a healthier skin barrier, characterized by lower superficial skin pH and enhanced barrier function.
- Findings highlight the importance of culturally-informed caregiver practices in managing and preventing diaper dermatitis.
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.
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