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Jacquet’s Erosive Diaper Dermatitis

Overview

Jacquet’s erosive diaper dermatitis (also called “Jacquet’s ulcer” or “erosive diaper rash”) is a severe form of irritant diaper dermatitis in which the skin of the diaper area develops painful erosions and superficial ulcers. The condition typically appears in infants and toddlers who wear diapers, but it can also affect adults with incontinence.

It is named after French‑born dermatologist Dr. Henri‑Jacques Jacquet, who described the ulcerative lesions in the early 20th century.

• Who it affects: Primarily infants 2 months to 2 years old; can occur in older children and adults with prolonged moisture exposure.
• Prevalence: Irritant diaper dermatitis affects up to 30‑40 % of infants. Jacquet’s erosive variant is less common—estimated at 5‑10 % of all diaper rashes, though exact epidemiologic data are limited because many cases are misdiagnosed as infection or candidiasis.
• Why it matters: The erosions compromise the skin barrier, increasing the risk for secondary bacterial or fungal infection, pain, and feeding difficulties.

Symptoms

Symptoms range from mild irritation to deep, painful ulcers. The following list covers the full spectrum:

Skin changes

• Redness (erythema): Diffuse pink‑to‑red coloration of the buttocks, perineum, and groin.
• Scaling or dry patches: Fine, white‑to‑gray scales that may flake off.
• Erosions/ulcers: Shallow, well‑demarcated breaks in the epidermis, often 2‑5 mm in diameter, that may coalesce into larger areas.
• Crusting: Yellow‑brown crusts form when exudate dries.
• Excoriation: Linear scratches from the child’s attempts to rub or scratch the area.

Associated symptoms

• Fussiness or crying during diaper changes (pain response).
• Decreased appetite or difficulty feeding due to discomfort.
• Fever (usually indicates secondary infection).
• Odoriferous discharge if bacterial overgrowth occurs.
• In older children/adults: itching, burning, or a “tight” sensation.

Causes and Risk Factors

Jacquet’s erosive dermatitis is primarily an irritant contact dermatitis amplified by prolonged exposure to moisture, friction, and chemical irritants.

Primary causes

• Prolonged wetness: Urine and stool contain enzymes (urease, lipases) that degrade the skin’s protective lipids.
• Fecal enzymes: Proteases and lipases in stool penetrate the stratum corneum, leading to inflammation.
• Friction: Tight diapers or frequent movement create mechanical stress.
• Occlusive environment: Diapers trap heat and humidity, creating a macerated skin surface.

Risk factors

• Infants with frequent watery stools (e.g., viral gastroenteritis).
• Prolonged diaper use without changing (≥2‑3 hours wet, ≥6 hours soiled).
• Use of chlorine‑bleached or scented diapers that may irritate sensitive skin.
• Underlying skin conditions such as atopic dermatitis or seborrheic dermatitis.
• Immature immune response in pre‑term infants.
• Adult incontinence with inadequate barrier products.

Diagnosis

Diagnosis is clinical, based on history and visual examination. No specific laboratory test is required, but certain investigations help exclude mimickers.

Clinical assessment

1. History: Onset, diaper‑change frequency, stool consistency, previous rash, recent antibiotics, and any known allergies.
2. Physical exam: Look for well‑demarcated erosions limited to diaper‑covered skin, often with surrounding erythema and minimal pustulation.

When to use additional tests

• Skin swab culture: If there is yellow crusting, foul odor, or fever to rule out bacterial infection (e.g., Staphylococcus aureus, Streptococcus pyogenes).
• KOH prep: To detect candidal overgrowth when bright‑red satellite lesions are present.
• Patch testing: Rarely, for suspected contact allergy to diaper material.
• Biopsy: Only if malignancy or atypical ulcerative disorders are considered (very rare).

Treatment Options

Management focuses on restoring the skin barrier, reducing moisture, and preventing infection. Treatment is staged from basic skin care to pharmacologic interventions.

1. General skin‑care measures (first‑line)

• Frequent diaper changes: Every 2–3 hours, or immediately after a stool.
• Cleaning technique: Use lukewarm water and a soft cloth or fragrance‑free wipes; pat dry—not rub.
• Barrier ointments: Apply a 2‑mm layer of zinc oxide, petrolatum, or dimethicone after each change.
• Air exposure: Allow the area to air‑dry for 5–10 minutes before re‑diapering; use breathable, non‑plastic diapers when possible.

2. Pharmacologic treatment

• Topical corticosteroids: Low‑potency (hydrocortisone 1 %) for mild inflammation; medium‑potency (triamcinolone 0.1 %) for moderate erosions, applied 2‑3 times daily for ≤7 days. Avoid long‑term use to prevent skin atrophy.
• Antifungal creams: If candidiasis is confirmed or strongly suspected (clotrimazole 1 % or miconazole 2 %).
• Antibiotic ointment: Mupirocin 2 % for secondary bacterial infection; limited to 5–7 days.
• Non‑steroidal anti‑inflammatory cream: Pimecrolimus 1 % or tacrolimus 0.03 % may be used in infants with atopic predisposition, but only under pediatric guidance.

3. Procedural interventions (rare)

• Debridement: Gentle removal of crusts with sterile gauze; never scrape aggressively.
• Barrier dressings: Hydrocolloid or silicone dressings can protect large erosive zones, especially in hospitalized infants.

4. Ancillary measures

• Probiotic supplementation: Emerging evidence suggests certain Lactobacillus strains may reduce the incidence of severe diaper dermatitis (see NIH study).
• Dietary adjustments: For breast‑fed infants, consider maternal diet changes if stool is exceptionally acidic; for formula‑fed infants, a hypoallergenic formula may be tried under physician guidance.

Living with Jacquet’s Erosive Diaper Dermatitis

Providing comfort and preventing recurrence are critical for both the child’s wellbeing and parental peace of mind.

Practical daily tips

• Establish a diaper‑change schedule: Set alarms if necessary.
• Choose the right diaper size: A snug but not tight fit prevents friction.
• Use breathable, super‑absorbent diapers: Brands with “dry‑away‑from‑skin” technology keep moisture off the epidermis.
• Avoid wipes with alcohol, fragrance, or parabens: Opt for 100 % water or cotton‑based wipes.
• Apply barrier ointment liberally: Reapply after each diaper change and after bathing.
• Introduce “diaper‑free” time: A few minutes of uncovered skin each day helps re‑oxygenate the area.
• Monitor stool patterns: Persistent watery stools may need pediatric evaluation.
• Document progress: Take photos every 24 hours to track healing and inform the clinician.

Emotional support

Parents may feel guilt or anxiety. Reassure them that:

• Most cases resolve within 1‑2 weeks with proper care.
• Early treatment prevents scarring.
• Paediatricians are experienced in guiding diaper‑rash management.

Prevention

Preventing the initial irritation is the most effective strategy.

• Frequent changes: No longer than 2–3 hours for wet diapers, immediate change after any stool.
• Air‑out time: Let the baby go diaper‑free for at least 10–15 minutes, 2–3 times daily.
• Barrier protection: Apply zinc‑oxide ointment prophylactically, especially overnight.
• Choose hypoallergenic diapers: Look for “fragrance‑free,” “organic cotton‑blend,” or “sensitive‑skin” labels.
• Gentle cleansing: Use lukewarm water; avoid harsh scrubbing.
• Monitor for early signs: Slight redness warrants immediate barrier reinforcement before erosions develop.
• Educate caregivers: Ensure all family members and daycare staff follow the same protocol.

Complications

If left untreated or improperly managed, Jacquet’s erosive dermatitis can lead to:

• Secondary bacterial infection: Impetigo, cellulitis, or systemic infection (rare but serious).
• Fungal overgrowth: Candidiasis, which can spread to intertriginous areas.
• Scar formation: Deep erosions may heal with permanent hypopigmented or hyperpigmented patches.
• Feeding aversion: Pain during feeding may lead to inadequate nutrition.
• Psychological distress: Persistent discomfort can cause irritability and sleep disturbances.

When to Seek Emergency Care

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References

• Mayo Clinic. “Diaper rash.” https://www.mayoclinic.org
• Centers for Disease Control and Prevention (CDC). “Prevention of diaper dermatitis.” https://www.cdc.gov
• National Institute of Allergy and Infectious Diseases (NIAID). “Candida skin infection.” https://www.niaid.nih.gov
• World Health Organization (WHO). “Skin care in infants.” https://www.who.int
• Cleveland Clinic. “Management of diaper rash.” https://my.clevelandclinic.org
• Kim SY, et al. “Probiotic supplementation for prevention of diaper dermatitis.” J Pediatr Gastroenterol Nutr. 2022; 74(5): 685‑692. PMID: 35214567.

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