Diaper Dermatitis Treatment & Management

  • Author: Ruchir Agrawal, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 4, 2011
 

Medical Care

Provide education regarding diaper dermatitis to patient, parents, and/or caregivers (see Patient Education).

  • Ideally, the first-line therapy for individuals with diaper dermatitis is zinc oxide ointment or various products containing zinc oxide.[5] 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.
  • 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.
  • 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. 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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Surgical Care

Generally, no surgical intervention is needed. However, if a diagnosis other than diaper dermatitis is suspected from the presentation or the lack of response to traditional treatment, a biopsy may be indicated.

  • In rare incidents of diaper dermatitis, a break in the skin can lead to the inoculation of group A beta hemolytic streptococci (GABHS) or other aerobic and anaerobic organisms, causing necrotizing fascitis (NF).
  • Recognition of this condition is extremely important because disease tends to progress quickly through the fascial plane.
  • Initially, the skin may appear erythematous and edematous, but crepitus, cutaneous ulceration, necrosis, bullae, and abscesses soon develop.
  • Early recognition, empirical treatment with antibiotics, and surgical debridement is essential for lower morbidity and mortality.
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Consultations

A pediatric dermatologist consultation may be indicated for the following:

  • Atypical incidents of diaper dermatitis
  • Patients who are immunocompromised
  • Individuals who present with comorbidities
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Activity

The diaper area may be left open to air or covered with a topical emollient.

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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 Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association

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 and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

  1. Runeman B. Skin interaction with absorbent hygiene products. Clin Dermatol. Jan-Feb 2008;26(1):45-51. [Medline].

  2. Jordan WE, Lawson KD, Berg RW, et al. Diaper dermatitis: frequency and severity among a general infant population. Pediatr Dermatol. Jun 1986;3(3):198-207. [Medline].

  3. Collipp PJ, Kuo B, Castro-Magana M, et al. Hair zinc, scalp hair quantity, and diaper rash in normal infants. Cutis. Jan 1985;35(1):66-70. [Medline].

  4. Benedix F, Hermann U, Brod C, et al. [Transient zinc deficiency in preterm infants]. Hautarzt. Jul 2008;59(7):563-6. [Medline].

  5. 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. Oct 2009;31(5):369-74. [Medline].

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

  7. Berg RW, Milligan MC, Sarbaugh FC. Association of skin wetness and pH with diaper dermatitis. Pediatr Dermatol. Mar 1994;11(1):18-20. [Medline].

  8. Boiko S. Treatment of diaper dermatitis. Dermatol Clin. Jan 1999;17(1):235-40, x. [Medline].

  9. Darmstadt GL, Dinulos JG. Neonatal skin care. Pediatr Clin North Am. Aug 2000;47(4):757-82. [Medline].

  10. Ferrera PC, Dupree ML, Verdile VP. Dermatologic problems encountered in the emergency department. Am J Emerg Med. Oct 1996;14(6):588-601. [Medline].

  11. Gokalp AS, Aldirmaz C, Oguz A, et al. Relation between the intestinal flora and diaper dermatitis in infancy. Trop Geogr Med. Jul 1990;42(3):238-40. [Medline].

  12. Higuchi R, Mizukoshi M, Koyama H, et al. Intractable diaper dermatitis as an early sign of biotin deficiency. Acta Paediatr. Feb 1998;87(2):228-9. [Medline].

  13. Janniger CK, Thomas I. Diaper dermatitis: an approach to prevention employing effective diaper care. Cutis. Sep 1993;52(3):153-5. [Medline].

  14. Kazaks EL, Lane AT. Diaper dermatitis. Pediatr Clin North Am. Aug 2000;47(4):909-19. [Medline].

  15. Lane AT. Resolving controversies in diaper dermatitis. In: Contemporary Pediatrics. Vol 3. 1986:45-55.

  16. Longhi F, Carlucci G, Bellucci R, et al. Diaper dermatitis: a study of contributing factors. Contact Dermatitis. Apr 1992;26(4):248-52. [Medline].

  17. 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. Oct 2005;57(5):305-11. [Medline].

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

  19. Metry DW, Hebert AA. Topical therapies and medications in the pediatric patient. Pediatr Clin North Am. Aug 2000;47(4):867-76. [Medline].

 
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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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