What are alternative moisturizers to zinc oxide cream for daily hospital application in a patient with friction-induced skin rash, who is also using Interdry (interdry ag) and Clotrimazole (clotrimazole)?

From the Guidelines

For a friction-skin rash in the hospital setting where zinc oxide cream is unavailable, I recommend using moisturizers packaged in tubes, such as water-based moisturizers, as primary alternatives to prevent contamination and ensure safety under gloves. When considering alternatives to zinc oxide cream for daily hospital application of a safe moisturizer, especially for a patient using InterDry and clotrimazole, it's crucial to prioritize products that are not only effective but also safe for use in a healthcare setting.

• Key considerations include:
  • Avoiding moisturizers in jars to prevent double dipping and potential contamination, as suggested by the American Contact Dermatitis Society 1.
  • Selecting moisturizers with a water base, which are safe to use under all types of gloves, including latex, vinyl, and nitrile, without causing breakdown of the glove material 1.
  • Looking for pocket-sized moisturizers for frequent reapplication, enhancing compliance and skin protection.
• Given these guidelines, water-based moisturizers in tube packaging are preferable for their safety profile and effectiveness in maintaining skin hydration without compromising the integrity of protective gloves.
• Additionally, applying moisturizer to damp skin, such as after soaking the hands in plain water, can enhance its effectiveness, as outlined in the "soak and smear" method 1.
• It's also important to note that while oil-based moisturizers can provide a strong barrier, they may not be suitable for all healthcare workers, especially those wearing latex or rubber gloves, due to the potential for glove deterioration 1.
• The patient's current use of InterDry and clotrimazole does not contraindicate the use of water-based moisturizers; instead, these moisturizers can complement the treatment by addressing the skin's need for hydration and protection against friction and irritants.

From the Research

Alternatives to Zinc Oxide Cream

Given that zinc oxide cream is not on the hospital formulary for friction-skin rash and the patient is also using Interdry and clotrimazole, alternatives can be considered based on the provided studies.

• Petrolatum-based ointments: These have been shown to be effective in skin protection and moisturizing, especially when combined with zinc oxide 2. However, since zinc oxide is not an option, a petrolatum-based ointment alone could be considered as a moisturizer.
• Barrier creams: While the study comparing zinc oxide to barrier creams for pressure injury prevention suggests zinc oxide might be more effective 3, barrier creams are still a viable option for daily moisturizing and skin protection, especially in the absence of zinc oxide.
• Miconazole nitrate ointment: This has been used effectively in treating diaper dermatitis complicated by candidiasis, often in combination with zinc oxide and petrolatum 4, 5. However, its use as a daily moisturizer might not be appropriate due to its antifungal properties, unless there's a specific indication for such treatment.

Considerations

• The choice of alternative should consider the patient's specific skin condition, the presence of candidiasis, and the need for moisturizing and skin protection.
• Interactions with Interdry and clotrimazole should be considered, although the provided studies do not directly address these combinations.
• The effectiveness of these alternatives might vary based on the individual patient's response and the specific formulation of the products used.