What is the treatment for diaper rash?

Treatment of Diaper Rash

For effective treatment of diaper rash, use emollient ointment to clean the diaper area instead of water or commercial wipes, and apply barrier creams to protect the infant's skin from moisture and irritants. 1

Assessment and Identification

• Look for signs of bacterial infection (crusting or weeping) or fungal infection in patients with diaper rash, as these may require specific treatment beyond standard care 1
• Assess for aggravating factors such as exposure to irritants, frequency of diaper changes, and type of diapers used 1
• Determine if the infant has sensitive skin or atopic tendencies, which may increase susceptibility to diaper rash 1

Treatment Strategies

Cleaning and Protection

• Use emollient as a soap substitute to cleanse the diaper area instead of water or commercial wipes that may contain irritants 1
• After bathing, allow the skin to dry thoroughly before applying any powder or barrier cream 1
• Apply barrier creams containing zinc oxide to protect the skin from moisture and irritants 1
• For blistered skin in the diaper area, use a hydrogel dressing to promote healing 2, 1

Diaper Management

• Line diapers with a soft cloth liner coated with emollient or paraffin-impregnated gauze to reduce friction 2, 1
• Trim off the inner elastic of disposable diapers to reduce friction against the skin 2, 1
• Change diapers frequently to keep the area as dry as possible 3
• Consider using superabsorbent disposable diapers, which are known to reduce the incidence of diaper dermatitis 3

Medication Considerations

• For mild inflammation, low-potency topical corticosteroids may be used, but avoid using them in the genital area without medical supervision 4
• FDA warns against using hydrocortisone for diaper rash without consulting a doctor 4
• For suspected fungal infections (particularly with bright red rash and satellite lesions), antifungal creams may be necessary 5

Warning Signs Requiring Medical Attention

• Seek medical evaluation if:
  • The rash worsens or persists despite home treatment 4
  • Signs of infection develop (increased redness, warmth, swelling, or pus) 1
  • The rash spreads beyond the diaper area 5
  • The child appears uncomfortable or has fever 5

Common Pitfalls to Avoid

• Do not use commercial wipes containing alcohol or fragrances that can irritate skin 1
• Avoid using hydrocortisone products without consulting a doctor, especially for children under 2 years of age 4
• Do not use tight-fitting diapers that increase friction and moisture retention 6
• Avoid using talc, as it can be irritating to inflamed skin 6
• Do not wash the diaper area excessively, as this can disrupt the skin barrier 6, 7

Prevention Strategies

• Keep the diaper area as dry as possible with frequent diaper changes 3
• Allow for diaper-free time to air out the skin 8
• Use barrier creams preventively, especially overnight or during times when diaper changes may be less frequent 1
• Consider the A-B-C-D-E approach: Airing, Barrier application, Cleansing properly, Diaper selection, and Education of caregivers 8