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To the Editor.—
In the Dec 22, 1977, Pediatric Alert, Dr Kenneth A. Arndt reviews the article by J. J. Leyden et al on "Urinary Ammonia and Ammonia-Producing Microorganisms in Infants With and Without Diaper Dermatitis" (Arch Dermatol 113:1678, 1977) in which this relationship is reportedly "shot down." Based on the evidence in the original article, I can in no way agree.First, diaper dermatitis was described as "patchy areas of skin erythema with occasional papules." In contrast, true ammonia dermatitis is ulcerated, with skin eroded away and ulcers 5 to 15 mm in diameter; it usually involves the tip of the penis being eaten off and perhaps crusted over so that the baby has trouble voiding at times. Second, Leyden et al prove conclusively that the diapers tested were free of ammonia (and so could not cause ammonia dermatitis, obviously). Diapers with ammonia are characteristically found only at the
Auld WT. Ammonia Dermatitis. Arch Dermatol. 1978;114(10):1553–1554. doi:10.1001/archderm.1978.01640220094037
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