How is diaper dermatitis treated?

Updated: Oct 16, 2020
  • Author: Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Ideally, the first-line therapy for individuals with diaper dermatitis is zinc oxide ointment or various products containing zinc oxide. [25] Zinc oxide is an inexpensive treatment with the following properties:

  • Antiseptic and astringent

  • Significant role in wound healing

  • Low risk for allergic or contact dermatitis

Acetyl tocopherol has been evaluated in the neonatal intensive care unit (NICU) setting and proved to be safe and more effective than the commonly used skin ointments in the topical treatment of exulcerative skin lesions in neonates. [26] Topical 2% magnesium and bentonite have also been used. [27, 28]

Various over-the-counter (OTC) diaper rash medications may confuse parents and/or caregivers. Incidence of allergic contact dermatitis (ACD) due to emollients is increasing; however, toxicity is rare. The safest OTC emollient available for newborns is pure white petrolatum ointment, which acts by trapping water beneath the epidermis. Another safe alternative is Aquaphor ointment, which is composed principally of white petrolatum, mineral oil, and wood wax alcohol. It is more expensive than pure white petrolatum ointment. Petrolatum, zinc oxide, aluminum acetate solution (1-2-3 Paste) is a combination product and is both a skin protectant and has a drying effect on vesicular or wet dermatoses.

If candidiasis is suspected or proven by potassium hydroxide (KOH) preparation or culture, an antifungal agent effective against yeast is indicated. The author has good experience in using hydrocortisone cream (1%) twice daily and antifungal (nystatin cream, powder, or ointment; clotrimazole 1% cream; econazole nitrate cream; miconazole 2% ointment; or amphotericin cream or ointment) cream after every diaper change or at least 4 times per day. [29, 30] If significant inflammation is obvious, hydrocortisone 1% can be used for the first 1-2 days. Avoid higher strength topical steroids including combination including clotrimazole/betamethasone and nystatin/triamcinolone.


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