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—Let me try to respond to your letter by saying that when we started our studies we had an open mind-hopefully this is different than having a hole in my head as perhaps you have concluded.
The diapers of those with diaper dermatitis did have ammonia. The point I made was that the concentration was not significantly different from those free of a rash. Diaper squeezings represented the first diaper change in the morning.
The infants we sampled were diagnosed as having "ammoniacal dermatitis" by trained pediatricians. The cases you describe with ulcerations 5 to 15 mm in diameter are very rare. I have only seen one such case in ten years at Children's Hospital of Philadelphia.
Our studies, in which ammoniacal solutions were repeatedly applied to normal skin of adults and infants, contradict the concept of ammonia being capable of inducing a rash. As we pointed
Leyden JJ. Ammonia Dermatitis-Reply. Arch Dermatol. 1978;114(10):1554. doi:10.1001/archderm.1978.01640220095038