An update on diaper dermatitis

Clinics in Dermatology

Volumn 32, Issue 4, 2014, Pages 477-487

  Klunk, Christopher ^a   Domingues, Erik ^a   Wiss, Karen ^a  

^a UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALUMINUM ACETATE; ALUMINUM MAGNESIUM HYDROXIDE; BUFEXAMAC; DESONIDE; DEXPANTHENOL; DIPHENHYDRAMINE; EOSIN; GUAIAZULENE; HYDROCORTISONE VALERATE; LANOLIN; PETROLATUM; RETINOL; ZINC OXIDE; DERMATOLOGICAL AGENT;

ANTIBIOTIC THERAPY; BIODEGRADABILITY; CONTACT DERMATITIS; CORTICOSTEROID THERAPY; DIAPER DERMATITIS; DIFFERENTIAL DIAGNOSIS; DISEASE ASSOCIATION; DISPOSABLE EQUIPMENT; ENVIRONMENTAL IMPACT; EQUIPMENT DESIGN; HEALTH EDUCATION; HUMAN; HYGIENE; INCIDENCE; INFANT DIAPER; INFECTION SENSITIVITY; IRRITANT DERMATITIS; NOTE; PATCH TEST; PRIORITY JOURNAL; PSORIASIS; SKIN ALLERGY; SKIN FLORA; SKIN SENSITIZATION; STAPHYLOCOCCUS INFECTION; STREPTOCOCCUS INFECTION; ADVERSE EFFECTS; CANDIDIASIS, CUTANEOUS; DERMATITIS, SEBORRHEIC; DIAPER RASH; INFANT; INFANT WELFARE; NEWBORN; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX; TOPICAL DRUG ADMINISTRATION;

ADMINISTRATION, TOPICAL; CANDIDIASIS, CUTANEOUS; DERMATITIS, SEBORRHEIC; DERMATOLOGIC AGENTS; DIAPER RASH; DIAPERS, INFANT; HUMANS; INFANT; INFANT WELFARE; INFANT, NEWBORN; RISK ASSESSMENT; SEVERITY OF ILLNESS INDEX;

EID: 84903982654     PISSN: 0738081X     EISSN: 18791131     Source Type: Journal    
DOI: 10.1016/j.clindermatol.2014.02.003     Document Type: Note

References (126)

1. Verbov J.L. Skin problems in children. Practitioner 1976, 217:403-415.
2. Pratt A.G. Perianal dermatitis of the newborn. Am J Dis Child 1951, 82:429-432.
3. Tanino J., Steiner M., Benjamin B. The relationship of perianal dermatitis to fecal pH. J Pediatr 1959, 54:793-800.
4. Longhi F., Carlucci G., Bellucci R., et al. Diaper dermatitis: a study of contributing factors. Contact Dermatitis 1992, 26:248-252.
5. Odueko O.M., Onayemi O., Oyedeji G.A. A prevalence survey of skin diseases in Nigerian children. Niger J Med 2001, 10:64-67.
6. Nanda A., Al-Hasawi F., Alsaleh Q.A. A prospective survey of pediatric dermatology clinic patients in Kuwait: an analysis of 10,000 cases. Pediatr Dermatol 1999, 16:6-11.
7. Jordan W.E., Lawson K.D., Berg R.W., et al. Diaper dermatitis: frequency and severity among a general infant population. Pediatr Dermatol 1986, 3:198-207.
8. Philipp R., Hughes A., Golding J. Getting to the bottom of nappy rash. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood. Br J Gen Pract 1997, 47:493-497.
9. Ratnapandian S., Warner S.B. Modern diaper technology. Tappi J 1996, 79:173-177.
10. Alberta L., Sweeney S.M., Wiss K. Diaper dye dermatitis. Pediatrics 2005, 116:450-452.
11. U.S.Environmental Protection Agency Municipal Solid Waste Generation, Recycling, and Disposal in the United States Tables and Figures for 2010 2011, U.S. Government Printing Office, Pittsburgh, PA.
12. Soil Control Lab Analysis of material by aerobic biodegradation using ASTM Method D5338 Available at, [accessed 1/5/13]. http://www.gdiapers.com/assets/files/pdf/gDiapers-ASTM-test.pdf.
13. Hershkowitz A. Q&A. TLC "truly loving care for our kids and our planet." 1989, 1:2.
14. Aumonier S., Collins M., Garrett P. An Updated Lifecycle Assessment Study for Disposable and Reusable Nappies 2008, Environment Agency, Almondsbury, Bristol.
15. U.S.Environmental Protection Agency Study of Environmental Impacts of Selected Disposable Versus Reusable Products with Health Considerations 1978, U.S. Government Printing Office, Pittsburgh, PA.
16. Gillin P. Attack of the Customers: The Pampers Dry Max Crisis Available at, [accessed 12/17/12]. http://gillin.com/blog/2012/08/attack-of-the-customers-the-pampers-dry-max-crisis.
17. Jacob S.E., Herro E.M., Guide S., et al. Allergic contact dermatitis to Pampers Drymax. Pediatr Dermatol 2012, 29:672-674.
18. U.S.Consumer Product Safety Commission No Specific Cause Found Yet Linking Dry Max Diapers to Diaper Rash 2010, 10-331. U.S. Consumer Product Safety Commission, Available at http://www.cpsc.gov/en/Newsroom/News-Releases/2010/No-Specific-Cause-Found-Yet-Linking-Dry-Max-Diapers-to-Diaper-Rash/.
19. Mortz C.G., Bindslev-Jensen C., Andersen K.E. Prevalence, incidence rates and persistence of contact allergy and allergic contact dermatitis in The Odense Adolescence Cohort Study: a 15-year follow-up. Br J Dermatol 2013, 168:318-325.
20. U.S.Department of Health and Human Services National Ambulatory Medical Care Survey: 1995-1996 Summary. Vital Health Stat 1999, 13:41.
21. Hogeling M., Pratt M. Allergic contact dermatitis in children: the Ottawa hospital patch-testing clinic experience, 1996 to 2006. Dermatitis 2008, 19:86-89.
22. Jacob S.E., Brod B., Crawford G.H. Clinically relevant patch test reactions in children: a United States based study. Pediatr Dermatol 2008, 25:520-527.
23. Onken A.T., Baumstark J., Belloni B., et al. Atypical diaper dermatitis: contact allergy to mercapto compounds. Pediatr Dermatol 2011, 28:739-741.
24. Belhadjali H., Giordano-Labadie F., Rance F., et al. "Lucky Luke" contact dermatitis from diapers: a new allergen?. Contact Dermatitis 2001, 44:248.
25. Di Landro A., Greco V., Valsecchi R. "Lucky Luke" contact dermatitis from diapers with negative patch tests. Contact Dermatitis 2002, 46:48-49.
26. Roul S., Ducombs G., Leaute-Labreze C., et al. "Lucky Luke" contact dermatitis due to rubber components of diapers. Contact Dermatitis 1998, 38:363-364.
27. Giusti F., Massone F., Bertoni L., et al. Contact sensitization to disperse dyes in children. Pediatr Dermatol 2003, 20:393-397.
28. Storrs F. Dermatitis from clothing and shoes. Contact Dermatitis 1986, 283-337. Lea & Febiger, Philadelphia. A. Fischer (Ed.).
29. Pratt M., Taraska V. Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition. Am J Contact Dermatitis 2000, 11:30-41.
30. Hatch K.L., Maibach H.I. Textile dye allergic contact dermatitis prevalence. Contact Dermatitis 2000, 42:187-195.
31. Cronin E. Studies in contact dermatitis. 18. Dyes in clothing. Trans St Johns Hosp Dermatol Soc 1968, 54:156-164.
32. Sarko L., Ireland D. Case: 1:10-cv-00301-TSB Doc #: 54-2 Filed: 05/27/11 Available at, [accessed 12/17/12]. http://www.diaperclassactionsettlement.com/docs/sa.pdf.
33. Jacob S.E., Burk C.J., Connelly E.A. Patch testing: another steroid-sparing agent to consider in children. Pediatr Dermatol 2008, 25:81-87.
34. Smith W.J., Jacob S.E. The role of allergic contact dermatitis in diaper dermatitis. Pediatr Dermatol 2009, 26:369-370.
35. Asarch A., Scheinman P.L. Sorbitan sesquioleate, a common emulsifier in topical corticosteroids, is an important contact allergen. Dermatitis 2008, 19:323-327.
36. Castanedo-Tardan M.P., Jacob S.E. Allergic contact dermatitis to sorbitan sesquioleate in children. Contact Dermatitis 2008, 58:171-172.
37. Seidenari S., Giusti F., Pepe P., et al. Contact sensitization in 1094 children undergoing patch testing over a 7-year period. Pediatr Dermatol 2005, 22:1-5.
38. Heine G., Schnuch A., Uter W., et al. Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group. Contact Dermatitis 2004, 51:111-117.
39. Roul S., Ducombs G., Taieb A. Usefulness of the European standard series for patch testing in children. A 3-year single-centre study of 337 patients. Contact Dermatitis 1999, 40:232-235.
40. Beattie P.E., Green C., Lowe G., et al. Which children should we patch test?. Clin Exp Dermatol 2007, 32:6-11.
41. Andersen K.E., Hjorth N., Menne T. The baboon syndrome: systemically-induced allergic contact dermatitis. Contact Dermatitis 1984, 10:97-100.
42. Berg R.W. Etiology and pathophysiology of diaper dermatitis. Adv Dermatol 1988, 3:75-98.
43. Rebora A., Leyden J.J. Napkin (diaper) dermatitis and gastrointestinal carriage of Candida albicans. Br J Dermatol 1981, 105:551-555.
44. Benjamin L. Clinical correlates with diaper dermatitis. Pediatrician 1987, 14:21-26.
45. Gokalp A.S., Aldirmaz C., Oguz A., et al. Relation between the intestinal flora and diaper dermatitis in infancy. Trop Geogr Med 1990, 42:238-240.
46. Korting H.C., Braun-Falco O. The effect of detergents on skin pH and its consequences. Clin Dermatol 1996, 14:23-27.
47. Adam R., Schnetz B., Mathey P., et al. Clinical demonstration of skin mildness and suitability for sensitive infant skin of a new baby wipe. Pediatr Dermatol 2009, 26:506-513.
48. Berg R.W., Milligan M.C., Sarbaugh F.C. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol 1994, 11:18-20.
49. Boiko S. Treatment of diaper dermatitis. Dermatol Clin 1999, 17:235-240.
50. Cole W.G., Lingeman J.M., Adolph K.E. Go naked: diapers affect infant walking. Dev Sci 2012, 15:783-790.
51. Benjasuwantep B., Ruangdaraganon N. Infant toilet training in Thailand: starting and completion age and factors determining them. J Med Assoc Thai 2011, 94:1441-1446.
52. Humphrey S., Bergman J.N., Au S. Practical management strategies for diaper dermatitis. Skin Therapy Lett 2006, 11:1-6.
53. Beeckman D., Schoonhoven L., Verhaeghe S., et al. Prevention and treatment of incontinence-associated dermatitis: literature review. J Adv Nurs 2009, 65:1141-1154.
54. Filloux F. Toxic encephalopathy caused by topically applied diphenhydramine. J Pediatr 1986, 108:1018-1020.
55. Huston R.L., Cypcar D., Cheng G.S., et al. Toxicity from topical administration of diphenhydramine in children. Clin Pediatr 1990, 29:542-545.
56. Turner J.W. Death of a child from topical diphenhydramine. Am J Forensic Med Pathol 2009, 30:380-381.
57. Davies M.W., Dore A.J., Perissinotto K.L. Topical vitamin A, or its derivatives, for treating and preventing napkin dermatitis in infants. Cochrane Database Syst Rev 2005, (4):CD004300.
58. Wigger-Alberti W., Elsner P. Petrolatum prevents irritation in a human cumulative exposure model in vivo. Dermatology 1997, 194:247-250.
59. Xhauflaire-Uhoda E., Henry F., Pierard-Franchimont C., et al. Electrometric assessment of the effect of a zinc oxide paste in diaper dermatitis. Int J Cosmet Sci 2009, 31:369-374.
60. Zhai H., Willard P., Maibach H.I. Evaluating skin-protective materials against contact irritants and allergens. An in vivo screening human model. Contact Dermatitis 1998, 38:155-158.
61. Baldwin S., Odio M.R., Haines S.L., et al. Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper. J Eur Acad Dermatol Venereol 2001, 15:5-11.
62. Collipp P.J. Effect of oral zinc supplements on diaper rash in normal infants. J Med Assoc Ga 1989, 78:621-623.
63. Gehring W., Gloor M. Effect of topically applied dexpanthenol on epidermal barrier function and stratum corneum hydration. Results of a human in vivo study. Arzneimittelforschung 2000, 50:659-663.
64. Wananukul S., Limpongsanuruk W., Singalavanija S., et al. Comparison of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from diarrhea: a multicenter study. J Med Assoc Thai 2006, 89:1654-1658.
65. Wolff H.H., Kieser M. Hamamelis in children with skin disorders and skin injuries: results of an observational study. Eur J Pediatr 2007, 166:943-948.
66. Moller P., Lohmann M., Brynitz S. Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis. Dis Colon Rectum 1987, 30:106-107.
67. Rodriguez J.T., Huang T.L., Ferry G.D., et al. Treatment of skin irritation around enterostomies with cholestyramine ointment. J Pediatr 1976, 88:659-661.
68. White C.M., Gailey R.A., Lippe S. Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant. Ann Pharmacother 1996, 30:954-956.
69. Arad A., Mimouni D., Ben-Amitai D., et al. Efficacy of topical application of eosin compared with zinc oxide paste and corticosteroid cream for diaper dermatitis. Dermatology 1999, 199:319-322.
70. Lubec G. Treatment of diaper rash with Parfenac lipid ointment (bufexamac). A study by Austrian pediatricians. Padiatr Padol 1989, 24:227-236.
71. Berger S., Rufener J., Klimek P., et al. Effects of potato-derived protease inhibitors on perianal dermatitis after colon resection for long-segment Hirschsprung's disease. World J Pediatr 2012, 8:173-176.
72. Gunes T., Akin M.A., Sarici D., et al. Guaiazulene: a new treatment option for recalcitrant diaper dermatitis in NICU patients. J Matern Fetal Neonatal Med 2013, 26:197-200.
73. Kourounakis A.P., Rekka E.A., Kourounakis P.N. Antioxidant activity of guaiazulene and protection against paracetamol hepatotoxicity in rats. J Pharm Pharmacol 1997, 49:938-942.
74. Panahi Y., Sharif M.R., Sharif A., et al. A randomized comparative trial on the therapeutic efficacy of topical aloe vera and Calendula officinalis on diaper dermatitis in children. Sci World J 2012, 8:102-134.
75. Markham T., Kennedy F., Collins P. Topical sucralfate for erosive irritant diaper dermatitis. Arch Dermatol 2000, 136:1199-1200.
76. Lund C., Kuller J., Lane A., et al. Neonatal skin care: the scientific basis for practice. J Obstet Gynecol Neonatal Nurs 1999, 28:241-254.
77. Taquino L.T. Promoting wound healing in the neonatal setting: process versus protocol. J Perinat Neonatal Nurs 2000, 14:104-118.
78. Borkowski S. Diaper rash care and management. Pediatr Nurs 2004, 30:467-470.
79. Lund C.H., Osborne J.W., Kuller J., et al. Neonatal skin care: clinical outcomes of the AWHONN/NANN evidence-based clinical practice guideline. Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. J Obstet Gynecol Neonatal Nurs 2001, 30:41-51.
80. Adam R. Skin care of the diaper area. Pediatr Dermatol 2008, 25:427-433.
81. Ehretsmann C., Schaefer P., Adam R. Cutaneous tolerance of baby wipes by infants with atopic dermatitis, and comparison of the mildness of baby wipe and water in infant skin. J Eur Acad Dermatol Venereol 2001, 15:16-21.
82. Baer E.L., Davies M.W., Easterbrook K.J. Disposable nappies for preventing napkin dermatitis in infants. Cochrane Database Syst Rev 2006, (3):CD004262.
83. Nield L.S., Kamat D. Prevention, diagnosis, and management of diaper dermatitis. Clin Pediatr 2007, 46:480-486.
84. Scheinfeld N. Diaper dermatitis: a review and brief survey of eruptions of the diaper area. Am J Clin Dermatol 2005, 6:273-281.
85. Beguin A.M., Malaquin-Pavan E., Guihaire C., et al. Improving diaper design to address incontinence associated dermatitis. BMC Geriatr 2010, 10:86.
86. Ferraro-Borgida M.J., Mulhern S.A., DeMeo M.O., et al. Methemoglobinemia from perineal application of an anesthetic cream. Ann Emerg Med 1996, 27:785-788.
87. Guilbert J., Flamant C., Hallalel F., et al. Anti-flatulence treatment and status epilepticus: a case of camphor intoxication. Emerg Med J 2007, 24:859-860.
88. Jensen J.P. Transcutaneous absorption of boron from a baby ointment used prophylactically against diaper dermatitis. Nord Med 1971, 86:1425-1429.
89. Morra P., Bartle W.R., Walker S.E., et al. Serum concentrations of salicylic acid following topically applied salicylate derivatives. Ann Pharmacother 1996, 30:935-940.
90. Tush G.M., Kuhn R.J. Methemoglobinemia induced by an over-the-counter medication. Ann Pharmacother 1996, 30:1251-1254.
91. Samuel D. Deadly diapers. Br Med J 1970, 2:314.
92. Gonzalez J., Hogg R.J. Metabolic alkalosis secondary to baking soda treatment of a diaper rash. Pediatrics 1981, 67:820-822.
93. Pairaudeau P.W., Wilson R.G., Hall M.A., et al. Inhalation of baby powder: an unappreciated hazard. BMJ 1991, 302:1200-1201.
94. Greenberg H.L., Shwayder T.A., Bieszk N., et al. Clotrimazole/betamethasone diproprionate: a review of costs and complications in the treatment of common cutaneous fungal infections. Pediatr Dermatol 2002, 19:78-81.
95. Tempark T., Phatarakijnirund V., Chatproedprai S., et al. Exogenous Cushing's syndrome due to topical corticosteroid application: case report and review literature. Endocrine 2010, 38:328-334.
96. Guven A., Gulumser O., Ozgen T. Cushing's syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse?. J Pediatr Endocrinol Metab 2007, 20:1173-1182.
97. Semiz S., Balci Y.I., Ergin S., et al. Two cases of Cushing's syndrome due to overuse of topical steroid in the diaper area. Pediatr Dermatol 2008, 25:544-547.
98. Siklar Z., Bostanci I., Atli O., et al. An infantile Cushing syndrome due to misuse of topical steroid. Pediatr Dermatol 2004, 21:561-563.
99. Balkrishnan R., Cook J.M., Shaffer M.P., et al. Analysis of factors associated with prescription of a potentially inappropriate combination dermatologic medication among US outpatient physicians. Pharmacoepidemiol Drug Saf 2004, 13:133-138.
100. Gallup E., Plott T., Ciclopirox TS Investigators A multicenter, open-label study to assess the safety and efficacy of ciclopirox topical suspension 0.77% in the treatment of diaper dermatitis due to Candida albicans. J Drugs Dermatol 2005, 4:29-34.
101. Gibbs D.L., Kashin P., Jevons S. Comparative and non-comparative studies of the efficacy and tolerance of tioconazole cream 1% versus another imidazole and/or placebo in neonates and infants with candidal diaper rash and/or impetigo. J Int Med Res 1987, 15:23-31.
102. Spraker M.K., Gisoldi E.M., Siegfried E.C., et al. Topical miconazole nitrate ointment in the treatment of diaper dermatitis complicated by candidiasis. Cutis 2006, 77:113-120.
103. Bass J.W., Chan D.S., Creamer K.M., et al. Comparison of oral cephalexin, topical mupirocin and topical bacitracin for treatment of impetigo. Pediatr Infect Dis J 1997, 16:708-710.
104. Fortunov R.M., Hulten K.G., Hammerman W.A., et al. Evaluation and treatment of community-acquired Staphylococcus aureus infections in term and late-preterm previously healthy neonates. Pediatrics 2007, 120:937-945.
105. Koning S., Verhagen A.P., van Suijlekom-Smit L.W., et al. Interventions for impetigo. Cochrane Database Syst Rev 2004, (2):CD003261.
106. Koning S., van der Sande R., Verhagen A.P., et al. Interventions for impetigo. Cochrane Database Syst Rev 2012, 1:CD003261.
107. George A., Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003, 53:480-487.
108. Christensen O.B., Anehus S. Hydrogen peroxide cream: an alternative to topical antibiotics in the treatment of impetigo contagiosa. Acta Derm Venereol 1994, 74:460-462.
109. McFadden J., Valdimarsson H., Fry L. Cross-reactivity between streptococcal M surface antigen and human skin. Br J Dermatol 1991, 125:443-447.
110. Valdimarsson H., Baker B.S., Jonsdottir I., et al. Psoriasis: a T-cell-mediated autoimmune disease induced by streptococcal superantigens?. Immunol Today 1995, 16:145-149.
111. Valdimarsson H., Sigmundsdottir H., Jonsdottir I. Is psoriasis induced by streptococcal superantigens and maintained by M-protein-specific T cells that cross-react with keratin?. Clin Exp Immunol 1997, 107:21-24.
112. Nickoloff B.J. The immunologic and genetic basis of psoriasis. Arch Dermatol 1999, 135:1104-1110.
113. Krishnamurthy K., Walker A., Gropper C.A., et al. To treat or not to treat? Management of guttate psoriasis and pityriasis rosea in patients with evidence of group A Streptococcal infection. J Drugs Dermatol 2010, 9:241-250.
114. McFadden J.P. Hypothesis-the natural selection of psoriasis. Clin Exp Dermatol 1990, 15:39-43.
115. Owen C.M., Chalmers R.J., O'Sullivan T., et al. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev 2000, (2):CD001976.
116. Rosenberg E.W., Noah P.W., Zanolli M.D., et al. Use of rifampin with penicillin and erythromycin in the treatment of psoriasis. Preliminary report. J Am Acad Dermatol 1986, 14:761-764.
117. Vincent F., Ross J.B., Dalton M., et al. A therapeutic trial of the use of penicillin V or erythromycin with or without rifampin in the treatment of psoriasis. J Am Acad Dermatol 1992, 26:458-461.
118. Dogan B., Karabudak O., Harmanyeri Y. Antistreptococcal treatment of guttate psoriasis: a controlled study. Int J Dermatol 2008, 47:950-952.
119. Martin J.M., Green M., Barbadora K.A., et al. Erythromycin-resistant group A streptococci in schoolchildren in Pittsburgh. N Engl J Med 2002, 346:1200-1206.
120. Olson D., Edmonson M.B. Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis. Pediatr Infect Dis J 2011, 30:933-936.
121. Meury S.N., Erb T., Schaad U.B., et al. Randomized, comparative efficacy trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children. J Pediatr 2008, 153:799-802.
122. Jongen J., Eberstein A., Peleikis H.G., et al. Perianal streptococcal dermatitis: an important differential diagnosis in pediatric patients. Dis Colon Rectum 2008, 51:584-587.
123. Heath C., Desai N., Silverberg N.B. Recent microbiological shifts in perianal bacterial dermatitis: Staphylococcus aureus predominance. Pediatr Dermatol 2009, 26:696-700.
124. Kahlke V., Jongen J., Peleikis H.G., et al. Perianal streptococcal dermatitis in adults: its association with pruritic anorectal diseases is mainly caused by group B streptococci. Colorectal Dis 2013, 15:602-607.
125. Fortina A.B., Piaserico S., Larese F., et al. Diaminodiphenylmethane (DDM): frequency of sensitization, clinical relevance and concomitant positive reactions. Contact Dermatitis 2001, 44:283-288.
126. U.S.Department of Health and Human Services Household Products Database Available at, [accessed 12/20/13]. http://householdproducts.nlm.nih.gov/.