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Jacquet’s Ulcer – A Comprehensive Medical Guide

Overview

Jacquet’s ulcer (also called a Jacquet’s lesion) is a deep, painful ulcer that forms on the skin of a newborn’s diaper area (perineum, buttocks, genitalia, or inner thighs). It is considered a type of severe diaper dermatitis that has progressed to full‑thickness skin loss.

• Who it affects: Primarily infants < 12 months old, especially those who are premature, have low birth weight, or have prolonged exposure to a wet/soiled diaper.
• Prevalence: Severe diaper dermatitis, including Jacquet’s ulcer, occurs in roughly 5–7 % of hospitalized newborns and up to 20 % of pre‑term infants in neonatal intensive‑care units (NICUs) (CDC, 2022).
• Why the name? Described by French dermatologist Henri‑Jacques Jacquet in 1905, the term originally denoted a chronic ulcer of the buttocks seen in adult patients with chronic constipation. The pediatric usage evolved later to describe the deep, necrotic lesions seen in diaper‑area dermatitis.

Symptoms

Jacquet’s ulcer is usually recognized by a cluster of characteristic signs. Look for the following:

• Deep, punched‑out ulceration – a crater‑shaped sore that extends through the epidermis into the dermis.
• Erythema and swelling surrounding the ulcer.
• Yellowish‑white slough or necrotic tissue covering the base of the lesion.
• Bleeding or serous (clear) drainage – especially after diaper changes.
• Painful crying during diaper changes or when the area is touched.
• Foul odor due to bacterial proliferation.
• Secondary infection signs – increased redness, warmth, pus, or fever.
• Location – most commonly the perineal folds, scrotum/ labia, buttocks, or inner thighs.

Causes and Risk Factors

Underlying Mechanism

Jacquet’s ulcer results from prolonged exposure of the skin to irritants (urine, feces, moisture) that break down the protective stratum corneum. The resulting inflammation compromises skin integrity, allowing mechanical friction from diapers to cause a full‑thickness break. In many cases, a secondary bacterial or fungal infection accelerates tissue necrosis.

Key Risk Factors

• Immature skin barrier – premature infants have thinner epidermis and reduced ceramide content.
• Prolonged wetness – diapers left unchanged for >3 hours, especially in warm climates.
• Fecal contamination – especially liquid stool that contains digestive enzymes (lipases, proteases) that digest skin proteins.
• Use of harsh wipes or soaps – can strip natural oils.
• Underlying dermatologic conditions – eczema, ichthyosis, or genetic barrier defects.
• Medical devices – urinary catheters or nasogastric tubes that increase moisture.
• Immunocompromise – infants on steroids or chemotherapy.

Diagnosis

Diagnosis is primarily clinical, based on visual inspection and history. However, certain tests help confirm severity and rule out other conditions.

Step‑by‑step evaluation

1. History taking – duration of diaper use, frequency of changes, any previous diaper rash, feeding patterns, and presence of systemic symptoms (fever, irritability).
2. Physical examination – careful lighting and gentle retraction of the diaper to view the ulcer’s depth, edges, and drainage.
3. Differential diagnosis – rule out candidal diaper dermatitis, bacterial cellulitis, impetigo, intertrigo, and rarely, infantile hemangioma or trauma.
4. Microbiological cultures – if there is purulent discharge, a swab for bacterial (Staphylococcus aureus, Streptococcus pyogenes) and fungal (Candida spp.) cultures is recommended.
5. Skin‑surface pH testing – high pH (>5.5) predisposes to barrier breakdown; a simple pH strip can guide management.
6. Biopsy – rarely required, only if malignancy or atypical ulcer is suspected.

Treatment Options

Management focuses on three pillars: eliminate the irritant, promote healing, and prevent infection. Treatment is usually initiated in the outpatient setting unless systemic infection is evident.

1. Skincare and Barrier Restoration

• Frequent diaper changes – at least every 2–3 hours, and immediately after stool.
• Barrier creams/ointments – zinc oxide (e.g., Desitin®), petrolatum, or dimethicone; applied liberally after each change.
• Gentle cleansing – use warm water and a soft cloth; avoid alcohol‑based wipes or perfumed soaps.
• Air exposure – allow the area to air‑dry for 5–10 minutes before re‑diapering.

2. Pharmacologic Therapy

Medication	Indication	Typical Dose/Regimen
Topical antibiotic ointment (e.g., mupirocin 2 %)	Superficial bacterial colonization	Apply thin layer 2–3×/day for 5‑7 days
Topical antifungal cream (clotrimazole 1 % or nystatin)	Candida overgrowth	Apply twice daily for 7‑10 days
Low‑potency topical steroids (hydrocortisone 1 %)	Inflammation without infection	Apply once daily for ≤7 days

3. Wound Care Techniques

• Debridement – gentle removal of necrotic slough with sterile gauze; performed by a clinician to avoid further trauma.
• Non‑adhesive dressings – silicone‑bordered dressings (e.g., Mepitel®) or hydrocolloid pads that keep the ulcer moist yet protected.
• Antimicrobial dressings – silver‑impregnated dressings for heavily colonized wounds.

4. Systemic Therapy (if indicated)

• Oral antibiotics – e.g., amoxicillin‑clavulanate 30 mg/kg/day divided q12h for proven bacterial cellulitis.
• Oral antifungals – fluconazole 6 mg/kg single dose for severe candidal infection.

5. Surgical Intervention

Rarely needed, but deep, non‑healing ulcers may require limited excision and primary closure or skin grafting in severe cases, usually performed by a pediatric surgeon.

Living with Jacquet’s Ulcer

Even after the ulcer begins to heal, the diaper area remains vulnerable. Below are practical daily‑life tips for parents and caregivers.

• Establish a diaper‑change schedule – set alarms or use a chart.
• Choose breathable diapers – disposable diapers with a “wetness indicator” or cloth diapers with a super‑absorbent liner.
• Rotate diaper brands – if a particular brand appears to irritate the skin, try a hypoallergenic alternative.
• Monitor stool consistency – breast‑fed infants usually have looser stools; consider a probiotic (Lactobacillus reuteri) after consulting the pediatrician.
• Hand hygiene – wash hands before and after diaper changes to limit bacterial spread.
• Schedule follow‑up visits – re‑evaluate the ulcer every 2–3 days until complete re‑epithelialization.
• Document changes – take photos (with consent) to track healing progress.

Prevention

Prevention is more effective than treatment. Implement these evidence‑based measures:

1. Keep the area dry – change diapers promptly; use a breathable, well‑fitting diaper.
2. Barrier protection – apply a thin layer of zinc oxide or petrolatum at each change.
3. Gentle cleaning – warm water and soft cloth; avoid wipes containing alcohol, fragrance, or parabens.
4. Frequent air time – give the infant a “diaper‑free” period of 10–15 minutes several times a day.
5. Optimize nutrition – ensure adequate hydration and a balanced diet to produce formed stools.
6. Screen high‑risk infants – premature, low‑birth‑weight, or those with eczema should receive prophylactic barrier creams.
7. Educate caregivers – train all family members on proper diapering technique.

Complications

If left untreated or inadequately managed, Jacquet’s ulcer can lead to serious outcomes:

• Secondary bacterial infection → cellulitis, sepsis (rare but life‑threatening).
• Fungal overgrowth → extensive candidiasis.
• Scar formation → potential for skin contractures that affect mobility.
• Chronic pain → irritability and feeding difficulties.
• Hyperpigmentation or hypopigmented patches after healing.
• Systemic toxicity – especially in pre‑term infants with immature immune systems.

When to Seek Emergency Care

References

• Mayo Clinic. Diaper rash. https://www.mayoclinic.org
• Centers for Disease Control and Prevention. Skin infections in newborns. 2022. https://www.cdc.gov
• National Institutes of Health. Neonatal skin barrier development. 2021. https://www.nih.gov
• Cleveland Clinic. Diaper rash: Prevention and treatment. 2023. https://my.clevelandclinic.org
• World Health Organization. Guidelines on management of skin infections in infants. 2020. https://www.who.int

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