What is the treatment for diaper rash?

Treatment of Diaper Rash

For uncomplicated diaper rash, clean the area with emollient ointment rather than water or commercial wipes, apply barrier creams containing zinc oxide or petrolatum with each diaper change, and ensure frequent diaper changes with thorough drying between applications. 1, 2, 3

Initial Assessment

Before initiating treatment, examine the diaper area for specific features that guide management 1:

• Look for signs of bacterial infection (crusting, weeping) or fungal infection (satellite lesions, beefy red appearance) 1
• Identify aggravating factors such as recent antibiotic use, excessive moisture, or exposure to irritants 1
• Assess for atopic tendencies, as babies with sensitive skin may be more susceptible 1

First-Line Treatment Algorithm

Step 1: Cleansing and Drying

• Clean the diaper area with emollient ointment instead of water or commercial wipes 1
• Change wet and soiled diapers promptly 2
• Allow the area to dry completely before applying products 2
• Avoid commercial wipes containing alcohol or fragrances that can irritate skin 1
• Consider using zinc oxide powder after bathing to thoroughly dry the skin 1

Step 2: Barrier Protection

• Apply barrier creams containing zinc oxide or petrolatum with each diaper change, especially at bedtime when exposure to wet diapers may be prolonged 2, 3
• These products help seal out wetness and protect skin from moisture and irritants 1, 2
• Apply as needed to affected areas 2

Step 3: Friction Reduction

• Trim off the inner elastic of disposable diapers to reduce friction 1
• Line the diaper with a soft cloth liner coated with emollient or paraffin-impregnated gauze 1
• Use well-fitted standard diapers to minimize movement against skin 4

Management of Specific Presentations

For Eczematous Inflammation

• If inflammatory eczema develops with erythema and desquamation, use low-potency topical corticosteroids such as hydrocortisone 2.5% or prednicarbate 0.02% cream 1
• Avoid over-washing with hot water or harsh soaps, which damages the skin barrier 1

For Blistered Skin

• Use a hydrogel dressing (such as Intrasite Conformable dressing) for blistered skin in the diaper area 4, 1
• Apply wound dressing or barrier cream to bony prominences such as heels and elbows 4

For Suspected Infection

• Seek medical evaluation for appropriate antimicrobial treatment if bacterial or fungal infection is suspected 1
• Bacterial infection typically requires culture-directed antibiotics, usually flucloxacillin for Staphylococcus aureus 1

Common Pitfalls to Avoid

• Do not use commercial wipes with alcohol or fragrances 1
• Avoid over-washing, which damages the skin barrier 1
• Do not apply powder to wet skin—thorough drying is essential before powder application 1

Key Principle

The fundamental principle is keeping the skin in the diaper area as dry as possible through frequent diaper changes, proper cleansing with emollients, and consistent use of barrier protection. 5, 6 Superabsorbent disposable diapers are known to reduce the incidence of diaper dermatitis 5.