Tips for managing diaper rash

There are a lot of things that can be complicated when it comes to caring for infants, but treating diaper rash doesn’t necessarily need to be one of them, said Bernard A. Cohen, MD.

Cohen, who teaches dermatology and pediatrics at the Johns Hopkins School of Medicine and serves as director of the Johns Hopkins University Pediatric Dermatology and Cutaneous Laser Center as well as section editor of Dermcase for Contemporary Pediatrics, explained simple hygiene and hydration can offer some of the most effective relief to diaper rash.

There are many options for hygiene, but a simple washcloth or rag and water will work. There are many options now for wipes and other cleaning products, but a 2018 report shared that in study of 280 full-term infants there was no difference in diaper rash severity or overall skin condition whether specially formulated baby wipes or a simple washcloth with water were used to clean the diaper area.¹

The exception may be when there is already severe irritation, noted Cohen. When the skin is already irritated, petrolatum gauze or a washcloth moistened with mineral oil can be both an effective and soothing option for cleaning, he stated. Caregivers should also be cautioned not to be too aggressive with cleaning, and to use a gentle touch.

When it comes to creams and ointments, the same rule of simplicity applies, Cohen said. There are no magic potions when it comes to topical care, he noted. Instead, the focus should be on protecting the irritated area from further excoriation with moisturizing treatments or barrier creams.

“For children who have a history of diaper dermatitis, routinely put on [petrolatum-based] products. When kids have active problems, you could still use those, but you might want something that has a thicker barrier,” he stated.

Barrier creams don’t do as much to treat or heal diaper rash as they do to prevent further damage and keep irritants off the skin, he explained.

There is some evidence, however, that cream and ointments that contain certain ingredients—like magnesium,² zinc oxide, and sucralfate³—may speed healing. Meanwhile, products containing ingredients like boric acid, camphor, phenol, benzocaine, and salicylates should be used with caution or avoided altogether due to their risk of toxicity.¹

Cohen shared concerns about toxicity with some prescription treatments, as well. Combination ointments and topical corticosteroids are sometimes used in persistent diaper rash, but there can have serious consequences, he said. Topical steroid-based creams can increase side effects and toxicity risk, Cohen noted. When used as combination products, the risk increases, he added. If a steroid-based cream is used, it should be as a separate product to allow for closer control on dosing and application. These kinds of products should be used sparingly and tapered off. Antibiotic or antifungal ointments or medications may also be indicated when infection or yeast is the cause or a secondary problem with diaper rash, but these causes are not as common as simple irritation from wetness, urine, and feces.

Finally, reminding parents that the best way to treat diaper rash is to prevent continued irritation is key. Although frequent diaper changes and the use of super-absorbent diapers may not seem like an effective “cure,” this intervention alone can go far in treating irritation.

References

1. Blume-Peytavi U, Kanti V. Prevention and treatment of diaper dermatitis. Pediatric Dermatology. 2018;35(S1):s19-s23. doi: 10.1111/pde.13495.

2. Nourbakhsh SM, Rouhi-Boroujeni H, Kheiri M, et al. Effect of topical application of the cream containing magnesium 2% on treatment of diaper dermatitis and diaper rash in children a clinical trial study. J Clin Diagn Res. 2016;10(1):WC04-WC6. doi:10.7860/JCDR/2016/14997.7143.

3. Sajjadian N, Hashemian F, Kadivar M, Sohani S, Alizadeh P. Efficacy of topical sucralfate versus topical zinc oxide in diaper dermatitis: a randomized, double-blind study. Iranian Journal of Dermatology. 2012; 15(3):85-88.