What is the management of diaper rash?

Management of Diaper Rash

For effective management of diaper rash, use emollient to clean the diaper area, apply barrier creams, and reduce friction from diaper elastic on the skin to prevent skin breakdown and infection. 1

Identification and Assessment

• Diaper rash typically presents as erythematous rash occurring on the convex surfaces of skin under the diaper 2
• Look for signs of bacterial infection (crusting or weeping) or fungal infection 1
• Assess severity of erythema using a clinical scale (mild to severe) 3
• Determine if there are any aggravating factors such as exposure to irritants 1

Prevention and Treatment Strategies

Diaper Area Cleaning

• Use emollient to clean the diaper area instead of water or commercial wipes 1
• Clean the affected area with mild soap and warm water when practical, then rinse thoroughly 4
• Gently pat or blot dry with soft cloth rather than rubbing 4
• Avoid excessive bathing which can dry the skin 5

Barrier Protection

• Apply barrier creams to protect the infant's skin from moisture and irritants 2
• Use a nappy/diaper liner covered in emollient to reduce movement of diaper on skin 1
• For blistered skin in the diaper area, use a hydrogel dressing 1
• Apply wound dressing or barrier cream to bony prominences and trauma-exposed sites 1

Diaper Selection and Modification

• Use well-fitted standard diapers 1
• Trim off the inner elastic of disposable diapers to reduce friction 1
• Superabsorbent disposable diapers can reduce the incidence of diaper dermatitis 2
• Line diaper with a soft cloth liner coated with emollient or paraffin-impregnated gauze 1

Medication Use

• For inflammation, mild topical corticosteroids may be used for short periods 2
• For adults and children 2 years and older: apply hydrocortisone to affected area not more than 3-4 times daily 4
• For children under 2 years of age: consult a doctor before using hydrocortisone 4
• Avoid using hydrocortisone for diaper rash without consulting a doctor 4

Special Considerations

• Keep the diaper area as dry as possible with frequent diaper changes 2
• Avoid tight-fitting diapers that increase occlusion and friction 5
• Do not use petrolatum, talc, or fluorinated topical steroidal medications 5
• When possible, allow diaper-free time to air the skin 6

Warning Signs Requiring Medical Attention

• Stop treatment and consult a doctor if:
  • Condition worsens or symptoms persist for more than 7 days 4
  • Symptoms clear up but recur within a few days 4
  • There is rectal bleeding 4
  • The rash is accompanied by systemic symptoms 2

Treatment Algorithm

1. First-line approach: Frequent diaper changes, gentle cleaning with emollient, barrier cream application 1, 2
2. For persistent rash: Add diaper modification (trimming elastic, using liners) 1
3. For inflammatory rash: Consider short-term mild topical corticosteroid (for children >2 years) or consult doctor (for children <2 years) 4, 2
4. For suspected infection: Seek medical evaluation for appropriate antimicrobial treatment 1

Common Pitfalls to Avoid

• Using commercial wipes containing alcohol or fragrances that can irritate skin 1
• Applying hydrocortisone without medical advice, especially in children under 2 years 4
• Neglecting to change diapers frequently enough to keep the area dry 2
• Failing to recognize when diaper rash may be a manifestation of a more serious condition requiring medical attention 2