An 8-week infant male presented to paediatric dermatology with a 1-month history of a deteriorating perianal rash. Since birth, he had been unsettled and requiring hourly nappy changes because of loose, frequent bowel motions. He was exclusively breastfed.
Examination revealed symmetrical well-demarcated erythematous perianal erosions, typical of Jacquet erosive dermatitis (JED) (Figure 1). JED is a severe irritant dermatitis caused by prolonged contact with moisture and faecal enzymes. Despite the dramatic appearance, education on nappy use, barrier ointments, +/– a moderate topical steroid typically promote complete healing within weeks. The presented case was complicated by cow milk protein allergy (CMPA), symptoms of which settled with exclusion of dairy from the mother’s diet.
Figure 1.
Perianal ulceration, classical of Jacquet erosive dermatitis.
The move from re-usable to absorbent disposable nappies had made JED extremely rare and increasingly unfamiliar to the new generation of dermatologists and GPs alike. With the ever-growing culture of ‘eco-parents’ combined with a surging prevalence of CMPA,1,2 it is important we don’t forget this diagnosis just yet!
Patient consent
The patient’s parent gave consent for the publication of this letter and its image.
REFERENCES
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