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