What treatment is recommended for an adult with a rash similar to diaper rash?

Treatment of Diaper Rash in Adults

For adults with a rash similar to diaper rash, topical corticosteroids are recommended as first-line treatment, specifically hydrocortisone 1% cream applied to affected areas up to 3-4 times daily. 1

Identification and Causes

• Diaper-type rashes in adults typically present as erythematous inflammation in intertriginous areas (groin, buttocks, skin folds) due to moisture, friction, and irritation 2
• These rashes may resemble atopic dermatitis in presentation, with inflammation and pruritus in affected areas 3
• Contributing factors include moisture retention, skin maceration, increased pH from urine/feces, and potential secondary infection 2

Treatment Algorithm

First-Line Treatment:

• Apply mild-potency topical corticosteroid (hydrocortisone 1%) to affected areas up to 3-4 times daily 1, 3
• For intertriginous areas like the groin, avoid high-potency corticosteroids due to increased risk of skin atrophy 4
• Use barrier creams containing zinc oxide after cleansing to protect skin from moisture and irritants 5, 6

Cleansing and Preventive Measures:

• Gently clean affected areas with mild, pH-neutral cleansers and tepid water 3
• Pat dry thoroughly (avoid rubbing) to minimize further irritation 3
• Apply emollients regularly to maintain skin barrier function 3, 4
• Ensure affected areas remain dry; consider absorbent powders if appropriate 2

For Moderate to Severe Cases:

• If mild corticosteroids are insufficient, consider medium-potency topical corticosteroids for short-term use (1-2 weeks) in non-intertriginous areas 3
• For persistent cases with significant inflammation, consider tacrolimus 0.03% or 0.1% ointment as an alternative to corticosteroids 3
• Pimecrolimus 1% cream is another effective option for mild-to-moderate cases 3

For Cases with Suspected Secondary Infection:

• Consider combination products containing both corticosteroid and antimicrobial agents 3
• For fungal involvement, consider antifungal creams such as clotrimazole or miconazole 3

Special Considerations

• Avoid prolonged use of topical corticosteroids, especially in intertriginous areas, to prevent skin atrophy 4
• For persistent or recurrent rashes, evaluate for underlying conditions such as diabetes, immunosuppression, or contact dermatitis 3
• Zinc oxide-based barrier creams have shown superior efficacy compared to talcum powder in preventing and treating irritant dermatitis 7
• A clinical trial demonstrated significant improvement in diaper-type dermatitis with zinc oxide/petrolatum formulations, reducing skin erythema and irritation 8

Monitoring and Follow-up

• Assess improvement within 1-2 weeks of treatment initiation 4
• If no improvement occurs within 2 weeks, consider dermatology referral for further evaluation 9
• Watch for signs of secondary infection (increased redness, warmth, purulence) which may require additional antimicrobial therapy 4

Prevention Strategies

• Maintain good hygiene with gentle cleansing after toileting 3
• Apply barrier creams containing zinc oxide preventively in susceptible individuals 5, 6
• Use breathable, moisture-wicking undergarments to reduce humidity and friction 3
• For bedridden patients, implement regular position changes to reduce pressure and friction 2