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Diaper Dermatitis Medication

  • Author: Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 17, 2015
 

Medication Summary

Medical therapy for diaper dermatitis includes the use of protective topical agents, topical anticandidal agents, and, possibly, topical low-potency steroids.

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Protective topical agents

Class Summary

Ideally, first-line therapy for diaper dermatitis is zinc oxide ointment. The safest over-the-counter (OTC) emollient available for newborns is pure white petrolatum ointment. Another safe alternative is Aquaphor ointment, which is principally composed of white petrolatum, mineral oil, and lanolin. It is more expensive than pure white petrolatum ointment.

Petrolatum topical (Aveeno Skin Relief Healing Ointment, Neosporin Lip Health Overnight Renewal Therapy)

 

Petrolatum traps water beneath the epidermis.

Zinc oxide topical (Aveeno Baby Organic Harvest Diaper Rash Cream, Desitin, Desitin Creamy)

 

Zinc oxide has antiseptic and astringent properties. It plays a significant role in wound healing with low risk for allergic or contact dermatitis. To remove zinc oxide from the skin, mineral oil is more effective and easier than soap and water.

Petrolatum, zinc oxide, aluminum acetate solution (1-2-3 Paste)

 

This combination product is both a skin protectant and has a drying effect on vesicular or wet dermatoses.

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Antifungal agents

Class Summary

These agents are indicated for suspected candidiasis or proven candidal infection by potassium hydroxide (KOH) preparation or culture. Commonly used topical antifungal agents are nystatin cream or ointment and econazole nitrate cream.

Nystatin (Mycostatin)

 

Nystatin is a fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. It is effective against various yeasts and yeastlike fungi. It changes the permeability of fungal cell membranes after binding to cell membrane sterols, causing cellular contents to leak.

Clotrimazole topical (Lotrimin AF)

 

Clotrimazole topical is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. It disrupts fungal cell wall permeability, causing fungal cell death.

Econazole topical (Ecoza)

 

Econazole is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. It disrupts fungal cell wall permeability, causing fungal cell death.

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Topical steroids

Class Summary

Limit potent topical steroid use to a few days and to a small quantity. Avoid combination topical steroid/antifungal cream in the diaper area.

Hydrocortisone, topical (Cortaid, Cortizone, Westcort)

 

Hydrocortisone topical is an adrenocorticosteroid derivative suitable for application to the skin or external mucous membranes. It has mineralocorticoid and glucocorticoid effects, resulting in anti-inflammatory activity.

For diaper dermatitis, which has the appearance of irritant and candidal dermatitis, the author has good experience using hydrocortisone 1% cream or Desonide 0.05% cream (bid) with nystatin (qid).

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Contributor Information and Disclosures
Author

Ruchir Agrawal, MD Chief, Allergy and Immunology, Aurora Sheboygan Clinic

Ruchir Agrawal, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American Medical Association, American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Vijay Sammeta, MD Medical Information Services, Adventis Pharmaceutical

Disclosure: Nothing to disclose.

Isabelle Thomas, MD Associate Professor, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Chief of Dermatology Service, Veterans Affairs Medical Center of East Orange

Isabelle Thomas, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

References
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  2. Ravanfar P, Wallace JS, Pace NC. Diaper dermatitis: a review and update. Curr Opin Pediatr. 2012 Aug. 24(4):472-9. [Medline].

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  9. Xhauflaire-Uhoda E, Henry F, Pierard-Franchimont C, Pierard GE. Electrometric assessment of the effect of a zinc oxide paste in diaper dermatitis. Int J Cosmet Sci. 2009 Oct. 31(5):369-74. [Medline].

  10. Manzoni P, Gomirato G. [Effectiveness of topical acetate tocopherol for the prevention and treatment of skin lesions in newborns: a 5 years experience in a 3rd level Italian Neonatal Intensive Care Unit]. Minerva Pediatr. 2005 Oct. 57(5):305-11. [Medline].

  11. Blanco D, van Rossem K. A Prospective Two-Year Assessment of Miconazole Resistance in Candida Spp. with Repeated Treatment with 0.25% Miconazole Nitrate Ointment in Neonates and Infants with Moderate to Severe Diaper Dermatitis Complicated by Cutaneous Candidiasis. Pediatr Dermatol. 2013 May 16. [Medline].

  12. Farahani LA, Ghobadzadeh M, Yousefi P. Comparison of the Effect of Human Milk and Topical Hydrocortisone 1% on Diaper Dermatitis. Pediatr Dermatol. 2013 Apr 22. [Medline].

  13. Adam R. Skin care of the diaper area. Pediatr Dermatol. 2008 Jul-Aug. 25(4):427-33. [Medline].

  14. Martin E. Weisse Stephen C. Aronoff. Candida. Kliegman. Nelson Textbook of Pediatrics. 18th ed. Saunders; 2007. 231.

 
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A 3-week-old female infant with diaper rash. Satellite lesions can be observed. The patient was diagnosed clinically with candidal dermatitis and successfully treated with nystatin ointment.
 
 
 
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