What is the best treatment for diaper rash?

Best Treatment for Diaper Rash

The best treatment for diaper rash is to use emollient ointment as a protective barrier, clean the diaper area with emollient rather than water or commercial wipes, and use a soft cloth liner coated with emollient or paraffin-impregnated gauze in the diaper. 1

Prevention and Treatment Algorithm

Step 1: Identify the Cause and Severity

• Look for signs of:
  • Simple irritant contact dermatitis (redness, mild scaling)
  • Candida infection (bright red, satellite lesions)
  • Bacterial infection (crusting, weeping)
  • Severity (mild redness vs. extensive breakdown)

Step 2: Basic Care for All Diaper Rash

1. Frequent Diaper Changes

   • Change diapers as soon as they become wet or soiled

2. Proper Cleansing

   • Use emollient ointment to clean the diaper area instead of water or commercial wipes 1
   • Avoid soaps and detergents which remove natural skin lipids 1
   • For very moist lesions, consider a topical dusting powder 2

3. Barrier Protection

   • Apply zinc oxide/petrolatum-based barrier cream or ointment with each diaper change 1, 3
   • Line diaper with soft cloth liner coated with emollient or use paraffin-impregnated gauze 1

4. Diaper Modifications

   • Use well-fitted standard diapers 1
   • Trim off inner elastic of disposable diapers to reduce friction 1
   • Consider brief periods without diapers to air the skin

Step 3: Treatment Based on Type of Rash

For Simple Irritant Diaper Dermatitis:

• Apply zinc oxide/petrolatum barrier cream with each diaper change 3
• Products containing zinc oxide, petrolatum, and vitamin A have comparable effects on diaper dermatitis severity 4

For Candida (Fungal) Infection:

• Apply antifungal powder such as nystatin 2-3 times daily until healing is complete 2
• Continue barrier cream application with diaper changes

For Bacterial Infection:

• Obtain bacterial culture if needed
• Treat with appropriate topical or systemic antibiotics
• Continue barrier protection

Special Considerations

For Severe or Persistent Rash:

• Consider hydrogel dressings for blistered skin in diaper area 1
• A mild topical corticosteroid may be needed briefly for inflammation 1
• Avoid prolonged use of potent topical steroids in the diaper area due to increased absorption

Common Pitfalls to Avoid:

• Using greasy creams that might facilitate folliculitis due to occlusive properties 1
• Manipulating or rubbing irritated skin, which increases risk of infection 1
• Using alcohol-containing products that can dry and irritate the skin 1
• Assuming all diaper rashes are the same and not identifying fungal or bacterial components

Evidence Quality

The recommendations are based on high-quality evidence from clinical practice guidelines 1, with strong recommendations for using emollients, barrier creams, and proper diaper area care. The evidence supports that continuous application of zinc oxide/petrolatum formulations provides significant protection against diaper dermatitis 3.