What is the treatment for diaper rash?

Treatment of Diaper Rash

For uncomplicated diaper rash, use frequent diaper changes with liberal application of zinc oxide or petrolatum-based barrier creams at each change, clean with emollients instead of commercial wipes, and allow diaper-free time to keep the area dry. 1, 2

First-Line Management

Skin Care and Cleansing

• Use emollients to clean the diaper area instead of water or commercial wipes to avoid irritation from alcohol and fragrances that damage the skin barrier 1, 2
• Avoid over-washing with hot water or harsh soaps, which further compromises skin integrity 1
• Thoroughly dry the skin before applying any topical products 1

Barrier Protection

• Apply barrier ointments containing zinc oxide or petrolatum liberally with each diaper change to protect skin from moisture and irritants 2
• Zinc oxide powder may be used after bathing to thoroughly dry the skin, which reduces skin irritation rates 1
• Use a diaper liner covered in emollient to reduce friction from diaper movement on skin 1

Diaper Management

• Change diapers frequently to minimize contact time with urine and feces 2
• Allow "diaper-free" time to promote air exposure and drying 2
• Trim off the inner elastic of disposable diapers to reduce friction, and line with soft cloth coated with emollient or paraffin-impregnated gauze 1

Treatment of Eczematous Inflammation

If inflammatory eczema develops with erythema and desquamation on dry skin, apply low-potency topical corticosteroids such as hydrocortisone 2.5% or prednicarbate 0.02% cream for 3-4 times daily. 1

Important FDA Warning

• Do not use hydrocortisone for the treatment of diaper rash in children under 2 years of age without consulting a doctor 3
• For children 2 years and older, apply hydrocortisone to affected area no more than 3-4 times daily 3
• Stop use if condition worsens or persists beyond 7 days 3

Management of Complicated Cases

Fungal Infection (Candidiasis)

• Suspect candidal infection if the rash involves skin folds, has satellite lesions, or fails to improve with standard barrier therapy 1, 2
• Requires antifungal treatment (though specific agents not detailed in guidelines provided) 1

Bacterial Infection

• Look for crusting, weeping, or honey-colored discharge indicating bacterial infection 1, 2
• Obtain culture and initiate antibiotics—typically flucloxacillin for Staphylococcus aureus 1
• Topical or oral antibiotics may be necessary depending on severity 2

Blistered or Eroded Skin

• Apply hydrogel dressing (such as Intrasite Conformable) to blistered skin in the diaper area, particularly if epidermolysis bullosa is suspected 1, 2
• Apply wound dressing or barrier cream to bony prominences and trauma-exposed sites 1

Critical Red Flags Requiring Immediate Medical Attention

• Eczema herpeticum is a medical emergency: multiple uniform "punched-out" erosions or vesiculopustular eruptions require immediate systemic acyclovir and empirical antibiotics 2
• Any suspected infection requires medical evaluation for appropriate antimicrobial treatment 1
• Recent antibiotic use or excessive moisture may indicate aggravating factors requiring modified management 1

Common Pitfalls to Avoid

• Never use commercial wipes containing alcohol or fragrances that irritate and damage skin 1
• Avoid petrolatum alone, fluorinated topical steroids, and talc in routine management 4
• Do not apply powder to wet skin, as this prevents proper drying 1
• Recognize that babies with atopic tendencies have more sensitive skin and increased susceptibility 1