Can Aquaphor Be Used as a Barrier Diaper Cream?
Yes, Aquaphor (petrolatum-based ointment) can be effectively used as a barrier diaper cream for both infants and incontinent adults to prevent and treat diaper dermatitis.
Evidence Supporting Petrolatum for Diaper Care
The American Academy of Pediatrics specifically recommends petroleum jelly for diaper area protection, wound healing, and general moisturization in healthy infants 1. This recommendation is based on petrolatum's proven ability to:
- Create an effective moisture barrier by forming an occlusive film on the skin surface that prevents evaporation and protects against irritants 2
- Reduce transepidermal water loss (TEWL), which is critical in maintaining skin barrier integrity in the diaper area 2
- Provide lubricant and smoothing effects that protect skin from friction and moisture-related breakdown 2
Clinical Evidence of Effectiveness
Randomized controlled trials demonstrate that petrolatum-based formulations significantly reduce both the severity and incidence of diaper rash 3. In a study of 391 children aged 8-24 months, continuous topical administration of petrolatum formulations resulted in significant reductions in skin erythema and diaper rash compared to control products 3.
When combined with zinc oxide, petrolatum formulations show even greater protective effects, with up to 3.5-fold reduction in skin barrier damage and erythema 4. The formulation transfers effectively to skin during diaper use, with zinc oxide levels increasing from 4.2 μg/cm² at 3 hours to >8 μg/cm² at 24 hours 4.
Application Guidelines
For optimal barrier protection:
- Apply liberally to clean, dry skin in the diaper area with each diaper change 1
- Use sterile occlusive ointments like white petrolatum (Aquaphor) to decrease transepidermal water loss 2
- Apply at least twice daily, though more frequent application (3-8 times daily) may be needed for compromised skin 2
- Clean the diaper area with emollient ointment rather than water or commercial wipes to reduce friction 1
Important Considerations and Caveats
Avoid petrolatum in certain contexts: While petrolatum is recommended for diaper care, some experts note that occlusive ointments may theoretically increase the risk of cutaneous infections and impair sweating in neonates with severe barrier dysfunction 2. However, this concern applies primarily to collodion babies and severe congenital ichthyoses, not typical diaper dermatitis 2.
Do not use greasy creams during active folliculitis: If folliculitis develops in the diaper area, avoid occlusive products as they may facilitate bacterial overgrowth 2, 5. Switch to water-in-oil emollients or temporarily discontinue barrier creams until infection resolves 2.
Product selection matters: Choose fragrance-free, preservative-free formulations to minimize contact allergen exposure 1. Aquaphor fits this profile as a bland, thick emollient ointment 1.
When to Escalate Treatment
If diaper dermatitis persists despite appropriate barrier cream use:
- Consider secondary candidal infection, which requires antifungal therapy in addition to barrier protection 6
- Rule out underlying conditions such as seborrheic or atopic dermatitis that may require additional management 7
- Avoid fluorinated topical steroids in the diaper area due to increased absorption risk 7