What is the treatment for diaper (nappy) rash?

Treatment of Diaper Rash

The most effective treatment for diaper rash involves keeping the area clean and dry, applying barrier creams containing zinc oxide or petrolatum after each diaper change, and using low-potency topical corticosteroids for short periods if significant inflammation is present. 1

Causes and Assessment

Diaper rash (diaper dermatitis) is an acute inflammatory reaction of the skin in the diaper-covered area, resulting from multiple factors:

• Increased wetness/moisture
• Friction between skin and diaper
• Elevated pH due to urine
• Irritation from fecal enzymes
• Microorganisms (particularly Candida) 2

When evaluating diaper rash, look for:

• Extent and severity of erythema
• Presence of satellite lesions (suggesting fungal infection)
• Signs of secondary bacterial infection (crusting, weeping)
• Duration of the rash

Treatment Algorithm

Step 1: Basic Care Measures

• Frequent diaper changes to minimize skin contact with moisture and irritants 2
• Use superabsorbent disposable diapers with gelling material in their core 3
• Clean the diaper area with emollients rather than water or commercial wipes 1
• Avoid soaps, perfumes, and alcohol-based products 1

Step 2: Barrier Protection

• Apply barrier creams containing zinc oxide or petrolatum after each diaper change 1
• Consider using a soft lining coated with emollient inside the diaper to reduce friction 1
• For mild cases, barrier creams alone may be sufficient 4

Step 3: For Inflammatory Rash

• Apply low-potency (Class 6-7) topical corticosteroids for short periods (3-7 days) 1, 5
• Hydrocortisone 0.5-1% is appropriate for children over 2 years of age 5
• For children under 2 years, consult a doctor before using hydrocortisone 5
• Do not use more than 3-4 times daily 5

Step 4: For Suspected Fungal Infection

• If satellite lesions are present or rash persists beyond 3 days, add an antifungal agent 3
• Combination products containing both antifungal and mild corticosteroid may be used for fungal diaper dermatitis

Step 5: For Suspected Bacterial Infection

• If signs of bacterial infection are present (crusting, discharge, sudden worsening), consider systemic antibiotics 1
• Topical antibiotics are generally not recommended for non-infected dermatitis 1

Important Cautions

• Do not use hydrocortisone in the genital area if there is a vaginal discharge 5
• Stop using hydrocortisone if condition worsens or persists beyond 7 days 5
• Do not apply hydrocortisone directly to the rectum 5
• Seek medical attention if rectal bleeding occurs 5

Prevention Strategies

• Keep the diaper area clean and dry
• Change diapers frequently
• Allow diaper-free time to air out the area
• Use barrier creams preventatively
• Use superabsorbent disposable diapers 3

When to Refer

• Rash persists despite appropriate treatment for more than 2 weeks
• Signs of systemic illness
• Unusual appearance or distribution of rash
• Suspicion of other conditions that can mimic diaper dermatitis (psoriasis, Langerhans' cell histiocytosis) 3

Remember that most cases of diaper dermatitis will resolve with proper skin care and barrier protection. Topical corticosteroids should be used sparingly and for short durations to minimize potential side effects.