Unusual diaper dermatitis

A report describes a case of an otherwise healthy 1-week-old who presented with a diaper rash. Examination revealed perianal redness with shallow ulcerations, ulcerated papules, and islands of re-epithelialization. The child's parents reported using over-the-counter creams without any benefit. They even used Bacitracin for a possible bacterial infection, which further worsened the rash. Subsequent applications of nystatin, hydrocortisone, zinc oxide, and benzalkonium chloride creams also proved ineffective.

At approximately one month of age, the child presented at the dermatology clinic and received a tentative diagnosis of Jacquet's dermatitis. He received ketoconazole cream and a mixture of zinc oxide and benzyl benzoate/benzyl cinnamate to be applied after each diaper change (to cover fungal elements) as well as oral amoxicillin (to cover possible perianal streptococcal infection). 

His skin cultures were negative for fungal elements but were positive for Klebsiella oxytoca, which is normally present in gut/skin flora in low numbers but can also cause opportunistic infections. Klebsiella showed sensitivity to treatment with amoxicillin, although the child displayed no improvement in the rash. A subsequent course of cefdinir also didn't improve the lesions, and so, the child was prescribed mupirocin ointment and a 7-day course of prednisolone. 

The rash cleared gradually, leaving behind only mild erythema on completion of treatment, which cleared without additional therapy.

Source: Nasr HA, Tucker DC. Jacquet's Dermatitis: An Unusual Type of Diaper Rash. Contemporary Pediatrics. 2012. https://www.contemporarypediatrics.com/view/jacquets-dermatitis-unusual-type-diaper-rash