What is the best treatment for a 7-year-old boy with irritant dermatitis at the base of the penis due to nocturnal enuresis (bedwetting) while wearing pull-ups (protective underwear) at night?

Treatment of Irritant Dermatitis at the Base of Penis from Nocturnal Enuresis

Apply topical hydrocortisone cream to the affected area 3-4 times daily, combined with aggressive barrier protection and moisture management to prevent ongoing urine contact with the skin. 1

Immediate Topical Treatment

• Topical hydrocortisone cream (over-the-counter 0.5-1%) should be applied to the red, dry, chaffed skin 3-4 times daily for relief of irritation and inflammation caused by urine exposure 1
• The FDA-approved indication specifically includes "itching associated with minor skin irritations, inflammation, and rashes" which directly applies to this irritant dermatitis 1
• Treatment duration should not exceed 7 days without reassessment; if the condition worsens or persists beyond this timeframe, further evaluation is needed 1

Essential Barrier Protection and Skin Care

• Apply a thick barrier cream or ointment (zinc oxide-based diaper cream or petroleum jelly) to the affected area before putting on pull-ups each night to create a protective layer between urine and skin 2
• Use soap-free cleansers and avoid alcoholic solutions when cleaning the area, as these can worsen irritation 2
• Apply urea- or glycerin-based moisturizers during the day to restore the skin barrier 2
• Ensure the area is completely dry before applying barrier cream—gently pat dry rather than rubbing 1

Addressing the Underlying Enuresis Management

While treating the skin irritation is the immediate priority, optimizing enuresis management will prevent recurrence:

• Change wet pull-ups immediately upon waking to minimize prolonged skin contact with urine 3
• Consider having the child change into fresh, dry pull-ups if he wakes during the night 3
• Implement behavioral interventions including limiting evening fluid intake (especially caffeinated beverages), encouraging regular daytime voiding, and addressing any constipation 3
• At age 7, this child is now eligible for more intensive enuresis treatments like alarm therapy (66% success rate) if the family desires more definitive management of the bedwetting itself 3

Important Caveats

• Do not use hydrocortisone for diaper rash treatment per se—this is irritant dermatitis from urine exposure, which is different 1
• Avoid applying hydrocortisone directly into any skin folds or rectal area using fingers or applicators 1
• If there are signs of secondary infection (increased redness, warmth, pustules, or drainage), the child needs evaluation for possible bacterial or fungal superinfection requiring different treatment 2
• Stop hydrocortisone and reassess if the condition doesn't improve within 7 days or worsens despite treatment 1

Follow-Up Considerations

• Reassess the skin in 1-2 weeks to ensure resolution 2
• If irritation persists despite proper barrier protection and topical treatment, consider whether the pull-ups themselves might be causing contact dermatitis (switch brands) or if there's an underlying skin condition like atopic dermatitis 2
• Monthly follow-up for the enuresis itself helps maintain motivation and allows adjustment of management strategies 3