Skin Nodules Over the Diaper Area

Abstract

A 16-month-old girl, the product of a full-term pregnancy and normal vaginal delivery, was seen at the American University of Beirut (Lebanon) Medical Center because of asymptomatic lesions of 2 weeks' duration over the diaper area. The infant had had recurrent episodes of diaper rash since age 7 months. The last episode occurred 1 month prior to admission, for which she received a topical preparation containing triamcinolone acetonide, gramicidin, and nystatin with adequate improvement. However, after 2 weeks of treatment, a nodular eruption appeared over the diaper area. There was no history of atopy or atopic dermatitis, psoriasis, or seborrheic dermatitis. No powder preparations were applied to the region. Physical examination revealed erythematous, bluish, 1-to 3-cm, firm nodules over the buttocks, right inguinal region, and labia majora. In addition, there were mild, relatively well-demarcated, erythematous patches over the diaper area (Fig 1). The rest of the physical examination was normal. A representative biopsy specimen was taken from the right inguinal area (Figs 2 and 3).