ABSTRACT. Diaper dermatitis is a common problem in outpatient pediatric office settings. Although most diaper rashes represent a form of contact dermatitis in response to irritants in the diaper environment, other rashes may be the result of an allergen in the diaper. On the basis of clinical examination results for 5 patients and patch testing results for 2 patients, we suspect that the patients demonstrated allergic contact dermatitis in response to the various blue, pink, and green dyes in diapers. Although topically administered corticosteroids are useful in the treatment regimen, the preferred treatment for allergic contact dermatitis in the diaper area is the use of dye-free diapers for allergen avoidance. Patch testing may also be valuable in identifying the allergen, because allergen avoidance is the key to prevention of recurrent disease. Diaper dermatitis is a common problem in outpatient pediatric office settings. Although most diaper rashes represent a form of contact dermatitis in response to irritants in the diaper environment, other rashes may be the result of an allergen in the diaper. We present clinical findings for 5 patients with such rashes. CASE REPORTS Patient 1A 9-month-old male patient was referred to the dermatology clinic for evaluation of a red papular rash. He had a history of atopic dermatitis that was triggered by multiple foods. Prick testing performed by an allergist revealed sensitivities to egg yolks, egg whites, soy protein, wheat, oat, cow's milk protein, peanuts, and cat dander. The patient's symptoms had increased markedly over the past 2 to 3 months despite the use of various topical corticosteroids and moisturizers and the avoidance of the listed foods.On physical examination, the patient was noted to have erythematous papules and thin rough plaques on his trunk and extremities. Well-demarcated erythema was also noted on the buttocks, inguinal area (Fig 1), and suprapubic area, which correlated directly with the location of the green dye in his diaper. The patient was diagnosed with allergic contact dermatitis (ACD) with autoeczematization (id reaction). All symptoms improved markedly when he began wearing dye-free diapers; he received no other treatment.After clearance of the rash, the patient was brought back to the clinic for patch testing with Finn chambers on Scanpor tape (Epitest, Oy, Finland). Antigens were left in place for 48 hours and then removed. The patient was evaluated at 48 and 96 hours after placement. At 96 hours, he was found to have strong positive reactions (erythema, edema, and papules) to Disperse Red 17 and Disperse Blue 106 and weaker positive reactions (erythema and papules) to Disperse Red 1 and Disperse Blue 124. He developed no reaction to Disperse Yellow 9, Disperse Red 11, Disperse Blue 85, or p-tert-butyl-phenol-formaldehyde resin (patch test reagents from Trolab [Ferndale Laboratories, Ferndale, MI] Patient 2An 18-month-old male patient was referred to the dermatology clinic because of a persistent diaper rash. Symptoms had begun 4 month...

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