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Urinary ammonia and ammonia-producing microorganisms in infants with and without diaper dermatitis
Abstract:
Free ammonia was determined in diaper squeezings from 26 infants with "ammoniacal dermatitis" and in 82 controls. No significant difference was found (402 ppm in diaper dermatitis compared to 465 in controls). The groups did not differ with regard to the incidence of organisms capable of splitting ammonia from urea. Experimental application of highly ammoniacal urine on intact infant and adult skin failed to provoke a dermatitis. Erythema could be induced only when ammoniacal urine was applied occlusively to scarified skin. These findings do not support the notion that ammonia is a primary factor in common diaper rash, but do not exclude a possible role for further irritation in an already existent condition.
Insights
Free ammonia levels in diapers did not differ between infants with and without diaper rash. Ammonia did not cause dermatitis on intact skin, suggesting it
Area of Science:
- Pediatric Dermatology
- Microbiology
Background:
- Diaper rash, or ammoniacal dermatitis, is a common infant skin condition.
- The role of ammonia in diaper rash etiology is debated.
- Urea-splitting organisms in the gut microbiome may contribute to ammonia production.
Purpose of the Study:
- To investigate the association between free ammonia levels in diapers and ammoniacal dermatitis.
- To determine if ammonia exposure can induce dermatitis experimentally.
- To explore the role of ammonia in the pathogenesis of diaper rash.
Main Methods:
- Quantified free ammonia in diaper squeezings from infants with and without diaper rash.
- Assessed the incidence of urea-splitting organisms in both groups.
- Applied ammoniacal urine to intact and scarified infant and adult skin under occlusion.
Main Results:
- No significant difference in free ammonia concentrations was found between diaper dermatitis and control groups.
- The prevalence of ammonia-producing organisms was similar in both groups.
- Ammoniacal urine did not induce dermatitis on intact skin but caused erythema on scarified skin.
Conclusions:
- Ammonia is unlikely to be the primary cause of common diaper rash.
- Further irritation or pre-existing skin damage may be necessary for ammonia to exacerbate diaper rash.
- Findings do not exclude a secondary role for ammonia in established diaper dermatitis.