Umbilical dermatitis

Umbilical dermatitis is a common condition, with infection common in adults. It is usually associated with inadequate hygiene and deepening of umbilical cord caused by obesity.

The condition is really a dermatitis and analogous to intertrigo that often occurs between folds of the skin.

Although it is primarily a 'seborrhoeic' dermatitis, it frequently becomes secondarily infected with skin organisms.

The whole umbilicus may feel hard with dermatitis, especially if the discharge is secondary to another condition such as an ompholith (or, very rarely, a tumour deposit)

• if the infection spreads into the subcutaneous tissues and the opening of the umbilicus becomes narrowed by oedema, the whole umbilicus can turn into an abscess
  • most umbilical abscesses are associated with ompholiths
  • clinical presentation may be with a red, hot, tender swelling in and around the umbilicus - there may be exudation of pus

Mangement in adults:

• mild cases
  • removal of foreign bodies such as hair-tufts, ompholiths
  • good skin hygiene
  • topical treatment as for intertrigo (e.g. daktacort (R) or trimovate (R))
• moderate/severe cases
  • as for mild cases
  • if significant secondary infection then oral antibiotic to cover Staph aureus (e.g. flucloxacillin if not penicillin allergic)

Notes:

• umbilical discharge
  • may be caused by various congenital or acquired conditions
    • rarely due to embryonal anomalies, such as patent urachus, urachal cyst or sinus, patent vitelline duct, vitelline cyst or sinus
  • most common cause of umbilical discharge in adult is acquired conditions, such as omphalitis (may be secondary to ompholiths, hair tufts, or foreign body), umbilical abscess or pilonidal sinus disease
    • very rare causes include endometriosis and metastatic carcinoma
• finding of 'belly-button lint' is quite common among hairy man
  • usually it is washed off during bathing or shower and rarely does it cause any inflammation
    • has been suggested that abdominal hair is mainly responsible for directing the fibers from clothes into the navel where they are compacted
    • shaving abdominal hair can prevent lint accumulation in the umbilicus
• obesity, deep umbilicus, and poor hygiene may be predisposing factors for developing lint accumulation

Reference:

• Sarma DP, Teruya B. 'Lint ball' omphalitis, a rare cause of umbilical discharge in an adult woman: a case report.Cases J. 2009 Jul 27;2:7785. doi: 10.4076/1757-1626-2-7785.