What is the treatment for diaper rash with broken skin?

Treatment for Diaper Rash with Broken Skin

For diaper rash with broken skin, use emollient ointment to clean the area and apply a hydrogel dressing to wounds, followed by a barrier cream containing zinc oxide or petrolatum. 1

Step-by-Step Management Approach

Initial Assessment and Cleaning

1. Gently clean the affected area:
   • Use emollient ointment instead of water or commercial wipes 1
   • Pat or blot dry with soft cloth - never rub 1
   • Avoid soap which can further irritate broken skin

Treatment for Broken Skin Areas

1. For areas with broken skin/wounds:

   • Apply a hydrogel dressing (such as Intrasite Conformable) directly to wounds 1
   • This provides a moist healing environment while protecting the broken skin

2. For surrounding irritated skin:

   • Apply a medium-potency topical corticosteroid (like hydrocortisone) to reduce inflammation 2
   • Important: Use corticosteroids sparingly and only for short duration (no more than 3-4 times daily) 2
   • Do not use hydrocortisone for more than 7 days unless directed by a doctor 2

Barrier Protection

1. Apply a protective barrier cream containing:

   • Zinc oxide and/or petrolatum (with or without vitamin A) 1, 3
   • These create a physical barrier between skin and irritants

2. Line the diaper with:

   • Soft cloth liner coated with emollient or
   • Paraffin-impregnated gauze 1

Diaper Modifications

1. Use well-fitted standard diapers 1
2. Trim off inner elastic of disposable diapers to reduce friction 1
3. Consider super-absorbent disposable diapers with gelling material core 4
4. Change diapers frequently to minimize skin exposure to moisture and irritants 5

Special Considerations

When to Suspect Fungal Infection

• If rash persists more than 3 days despite treatment
• If satellite lesions (small red spots separate from main rash area) appear
• Action: Add an antifungal agent to the treatment regimen 4

Warning Signs Requiring Medical Attention

• Worsening condition despite treatment
• Symptoms persisting more than 7 days
• Symptoms clearing but recurring within days
• Rectal bleeding 2

Prevention Strategies

• Keep diaper area dry with frequent changes
• Use barrier creams preventatively
• Avoid tight diapers and plastic pants that trap moisture
• Allow for diaper-free time to air out the area 5, 3

Important Cautions

• Do not use hydrocortisone in the genital area if there is vaginal discharge 2
• Avoid contact with eyes when applying any treatment 2
• For children under 2 years, consult a doctor before using hydrocortisone 2
• Do not use multiple hydrocortisone products simultaneously 2

This treatment approach addresses both the inflammation and skin barrier dysfunction while protecting the broken skin from further damage, which is essential for proper healing and prevention of secondary infections.