Ammonia Dermatitis

Ammonia dermatitis is common in babies of the diaper age and is caused by the breaking down into ammonia of the urea in the urine on the diaper by bacteria from the bowel. Ammonia dermatitis is a classical example of dermatitis from a primary irritant- there is no allergic sensitization. There may be erythema with moderate peel­ing, papules, bullae, or actual ulceration, depending upon the concentra­tion of ammonia which contacts the skin. There is always in the diffuse erythematous type a sharp line of de­marcation following the line of the diaper. The diagnosis is made by the appearance and by the strong am­monia smell, particularly in the morn­ing, after the baby has had his wet diapers on all night.

I recommend that all young pedi­atricians read Cooke’s^* original paper in which he showed the cause of the trouble and recommended the first satisfactory treatment for it. He suggested that the diapers be soaked in mercuric chloride or in boric acid solution. The first works practically every time, the second is not much good. The diapers are washed and rinsed as usual, then soaked for an hour in a white enamel bucket three-fourths full of water in which one 7.3 grain tablet of mercuric chloride has been dissolved; then they are wrung out and allowed to dry with­out rinsing. This is the best treat­ment for ammonia dermatitis: I do not think any of the newer antisep­tics that have been recommended are nearly as good. In the last few years it has been shown that most children with acrodynia have been exposed to mercury, and two cases have been re­ported following the use of mercuric chloride as a diaper disinfectant.¹⁰ This must be very unusual, because for a long time most pediatricians have used Cooke’s method, and acrodynia, in New England at any rate, is a rare disease. I have used this treat­ment for thirty-four years, since Cooke’s original paper was published, for every baby that I have seen with ammonia dermatitis. There has been no acrodynia, no other child in the family has eaten the mercury tablets, and practically every patient treated has been cured entirely and com­pletely.

*Cooke, J. V.: Etiology and Treatment of Ammonia Dermatitis of the Gluteal Region in Infants, Am. J. Dis. Child. 23: 481, 1921.