What is the treatment for diaper dermatitis with open wounds?

From the Guidelines

For diaper rash with open wounds, it is crucial to seek medical attention promptly and follow a gentle skincare routine, as recommended by the most recent and highest quality study 1.

Key Recommendations

• Change diapers frequently (every 2-3 hours and after each bowel movement) and gently clean the area with warm water, avoiding wipes with alcohol or fragrance.
• Allow the skin to air dry completely before applying a thick layer of zinc oxide cream like Desitin or petroleum jelly to create a protective barrier.
• Leave the diaper loose or consider diaper-free time to promote healing.
• For open wounds, the doctor may recommend an antifungal cream like clotrimazole or nystatin if a yeast infection is present, or a mild hydrocortisone cream (0.5-1%) for inflammation, typically used for 3-7 days.
• Avoid talcum powder, which can irritate the lungs if inhaled.

Wound Care

• Use emollient and liners to reduce friction from nappy/diaper elastic on skin, as suggested by 1.
• Clean nappy/diaper area with emollient ointment in preference to water or commercial wipes.
• If skin has blistered, use a hydrogel dressing such as Intrasite Conformable dressing.

Prevention of Further Irritation

• Use well-fitted standard nappies/diapers and trim off the inner elastic of disposable nappies/diapers to reduce friction, as recommended by 1.
• Line nappy/diaper with a soft cloth liner coated with emollient or paraffin-impregnated gauze.
• Barrier creams and dressings may be useful in preventing further irritation.

Importance of Medical Attention

• Open wounds in diaper rash often result from prolonged exposure to moisture, friction, and digestive enzymes in stool that break down skin.
• Antibiotics, diarrhea, or changes in diet can worsen the condition by disrupting normal skin flora or increasing stool frequency, highlighting the need for prompt medical attention.

From the FDA Drug Label

When using this product avoid contact with eyes do not use more than directed unless told to do so by a doctor do not put directly into the rectum by using fingers or any mechanical device or applicator Stop use and ask a doctor if condition worsens, symptoms persist for more than 7 days or clear up and occur again within a few days for the treatment of diaper rash. Consult a doctor.

For diaper rash with open wounds, consult a doctor before using hydrocortisone (TOP) 2.

• The product should not be used for more than 7 days, or if the condition worsens.
• It is recommended to consult a doctor for the treatment of diaper rash. Alternatively, bacitracin (TOP) 3 can be used for skin infections, but it is essential to ask a doctor for children under 2 years of age.
• For adults and children over 2 years, apply a small amount of bacitracin (TOP) to the affected area 1 to 3 times daily.

From the Research

Diaper Rash with Open Wounds

• Diaper dermatitis is a common childhood affliction that can lead to open wounds if left untreated or not properly managed 4.
• The use of zinc oxide and petrolatum-based formulations has been shown to be effective in preventing and treating diaper dermatitis, including reducing the risk of open wounds 4, 5.
• A novel disposable diaper that delivers a zinc oxide and petrolatum-based formulation continuously to the skin during use has been shown to reduce skin erythema and diaper rash in infants 4.
• Topical skin barrier repair cosmetic products, such as a zinc gluconate-taurine/zinc oxide and panthenol/glycerin/Butyrospermum parkii butter barrier cream, have been shown to be effective in treating mild to moderate diaper dermatitis, including reducing erythema and promoting wound healing 5.
• Nonmedical skincare practices, such as the use of barrier emollients and improved diaper technology, can help prevent diaper dermatitis and promote healthy skin barrier function, reducing the risk of open wounds 6, 7.

Treatment and Prevention

• Frequent diaper changes and aeration, gentle cleansing, and the use of a barrier cream can help prevent and treat diaper dermatitis, including reducing the risk of open wounds 6, 7.
• The use of harsh cleaning products can exacerbate diaper dermatitis and increase the risk of open wounds 7.
• Novel combinations of topical agents, such as zinc gluconate, zinc oxide, dexpanthenol, and taurine, have been shown to be effective in treating diaper dermatitis and promoting wound healing 8.