Treatment of Diaper Dermatitis
The cornerstone of diaper dermatitis treatment is regular application of emollients combined with barrier protection, using low to medium potency topical corticosteroids only for inflammatory cases, while avoiding topical corticosteroids specifically for diaper rash per FDA labeling. 1, 2
First-Line Management: Barrier Protection and Emollients
Apply emollients regularly to provide both short-term and long-term protective effects in mild to moderate diaper dermatitis. 1
Clean the diaper area with emollient ointment rather than water or commercial wipes to minimize irritation. 1
Line diapers with soft cloth liners coated with emollient or paraffin-impregnated gauze to reduce friction against the skin. 1
Use well-fitted standard diapers and trim off inner elastic to reduce friction. 1
Keep the diaper area as dry as possible with frequent diaper changes. 3
Anti-Inflammatory Treatment for Moderate to Severe Cases
Important caveat: FDA labeling explicitly states "Do not use [hydrocortisone] for the treatment of diaper rash. Consult a doctor." 2 However, guidelines support judicious use of low to medium potency topical corticosteroids for inflammatory diaper dermatitis with specific precautions:
Use low to medium potency topical corticosteroids for inflammatory diaper dermatitis, limiting duration of exposure due to increased absorption in the diaper area and risk of systemic effects. 1
Apply topical corticosteroids to affected areas only, not more than twice daily, to minimize systemic absorption risk. 1
Consider topical PDE-4 inhibitors (such as crisaborole) for mild to moderate cases as an alternative to corticosteroids. 1
For moderate to very severe cases, wet-wrap therapy with topical corticosteroids can be used as an effective short-term second-line treatment. 1
Management of Secondary Infection
Add systemic antibiotics (flucloxacillin or erythromycin) if clinical signs of bacterial superinfection are present, rather than using topical antibiotics. 1
Do not use long-term topical antibiotics due to increased risk of resistance and skin sensitization. 1
Adjunctive Measures for Severe Cases
Oral antihistamines may be used for their sedative properties during severe flares to help with sleep disturbance, with large doses potentially required in children for sedative effect. 1
Bleach baths may be beneficial in some cases, but carefully weigh benefits and risks before use. 1
What NOT to Use
Avoid topical antihistamines as they increase the risk of contact dermatitis. 1
Do not apply topical antibiotics long-term. 1
Avoid high-potency corticosteroids in the diaper area due to increased absorption risk. 1
Common Pitfalls to Avoid
Using topical corticosteroids as general moisturizers rather than targeting only affected areas. 1
Applying corticosteroids more than twice daily, which increases systemic absorption risk. 1
Using topical corticosteroids for routine diaper rash without consulting a physician, as per FDA warnings. 2
Neglecting basic barrier protection with emollients, which is essential regardless of severity. 1