A diverse group of diseases can cause skin conditions in the diaper area including those which are directly caused by diapers or the diaper environment, some which are not directly due to, but are worsened by, the wearing of diapers, and those which are independent of the presence of the diaper or its resulting environment. Many of these conditions are limited to this area of the skin, but others extend to skin outside this area, and some are signs of systemic disease. We review many of the important causes of eruptions in the diaper area and emphasize key points in the differential diagnosis.Diagnosing rashes in the diaper area is an important skill. Diaper dermatitis (DD) is common, estimated to occur in 25% of children seeking care from a pediatrician (1). To help facilitate diagnosis, eruptions in the diaper region can be divided into three subgroups: skin conditions caused by the presence of the diaper, rashes exacerbated by the diaper (but not directly caused by it), and eruptions present regardless of the presence of the diaper (Table 1). DERMATITIS DUE TO THE DIAPER OR DIAPER ENVIRONMENTThe most common cause of DD is irritant DD (Fig. 1A), triggered by prolonged contact between the skin and urine and feces. Irritant DD is most prominent in areas where the diaper is in direct contact with the skin, particularly on the convex surfaces, typically sparing the inguinal creases and gluteal cleft. At the same time, an increasingly common location for irritant DD is the perianal skin, where, in the presence of frequent stools or diarrhea, the diaper is not able to adequately wick away feces. When severe, this can cause erosions (Fig. 1B). Clinical manifestations are variable and include redness, papules, scaling, superficial erosions, and, less commonly, elevated papules or nodules, referred to as "pseudoverrucous papules and nodules (PVPN)." PPVN ( Fig. 2) are typically due to chronic, severe irritant DD (2). Jacquet's DD, an erosive DD, and granuloma gluteal infantum, a nodular DD, are often considered on a spectrum with PVPN because they have the same predisposing factors. Management of irritant DD requires attention to multiple contributing factors. First, decreasing exposure to urine and liquid stool is paramount. This often

The predominant bacteria in microbiome studies of adult acne is Propionibacterium, whereas in this pediatric population we saw a lot of Streptococcus bacteria. After treatment, the microbiomes of intervention group participants more closely resembled those of control group participants.

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Skin cancer risk is elevated in solid organ transplant recipients (OTRs). Studies of skin cancer awareness and sun-protection behaviors in pediatric transplant recipients (pOTRs) have not been reported. We measured effects over time of a multimodal educational intervention on knowledge of sun-protection practices and skin cancer risk, engagement in sun-protection behaviors, and self-efficacy and perceived barriers to photoprotection in pOTRs, their guardians, and a comparison group of children and guardians. Knowledge about skin cancer risk increased in pOTRs and their guardians (P ≤ .01) and frequency of pOTRs’ sun-protection behaviors reported by pOTRs and their guardians also improved.

This article is available online at http://www.jlr.org However, data from studies conducted in rodents have shown that infusing palmitoleic acid (16:1n-7), which is normally produced in adipose tissue and the liver through lipogenesis, followed by desaturation of palmitic acid (16:0) by the stearoyl-CoA desaturase (SCD1) gene, augments skeletal muscle insulin signaling and increases insulin-mediated muscle glucose uptake ( 2 ). The importance of circulating palmitoleic acid in regulating insulin sensitivity in humans is unclear because of confl icting data from different studies, which have found that the percentage of palmitoleate in plasma FFA or lipids correlated directly with insulin sensitivity ( 3 ) or was greater in insulinresistant (IR) than insulin-sensitive (IS) subjects ( 4-8 ). Moreover, these studies did not measure absolute palmitoleate concentration, which provides a better assessment of palmitoleate availability to peripheral tissues, or palmitoleate within very low-density lipoprotein (VLDL), which may be an important contributor to tissue fatty acid delivery.The purpose of the present study was to determine whether impaired insulin-mediated skeletal muscle glucose uptake was associated with a decrease in plasma palmitoleic acid availability in obese people. Accordingly, we determined plasma free palmitoleic acid concentration, which is derived primarily from palmitoleate synthesized in adipose tissue, and palmitoleic acid content in VLDL, which is derived primarily from palmitoleate synthesized in the liver. Study subjects were specifi cally selected to be either IS or IR based on the increase in glucose uptake during a hyperinsulinemic-euglycemic clamp procedure. An increase in circulating free fatty acids (FFA) impairs insulin action in skeletal muscle and liver and likely contributes to the insulin resistance associated with obesity ( 1 ). DK-37948, UL1 RR-024992 (Clinical and Translational Science Award), DK 56341 (Nutrition and Obesity Research Center), and RR-00954 (Biomedical Mass Spectrometry Resource) Abbreviations: BMI, body mass index; BSA, body surface area; C t , threshold crossing; HISI, hepatic insulin sensitivity index; IR, insulin resistant; IS, insulin sensitive; Ra, rate of appearance; Rd, rate of disappearance; TG, triglyceride. This study was supported by National Institutes of Health Grants