Medical Care
Provide education regarding diaper dermatitis to patient, parents, and/or caregivers (see Patient Education). [21, 22, 23, 24]
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:
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Antiseptic and astringent
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Significant role in wound healing
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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.
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.
Consultations
A pediatric dermatologist consultation may be indicated for the following:
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Atypical incidents of diaper dermatitis
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Patients who are immunocompromised
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Individuals who present with comorbidities
Activity
The diaper area may be left open to air or covered with a topical emollient.
Prevention
Prevention of diaper dermatitis can be summarized with the acronym ABCDE (air, barrier, cleansing, diaper, and education).
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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.
