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Clinician’s Corner: Diaper Rash Treatment

Diaper rash is almost always caused by Candida albicans, and like any yeast thrives where it is warm, dark and moist.  Here are some treatment strategies to help manage diaper rash in our pediatric population.  It’s as easy as A, B,C, D & E.

A = air out the skin by allowing the child to go diaper-free, best to do on a hard surface floor for easy clean up. Don’t expose to sun for longer periods of time to prevent possible sunburn.

B = barrier; use a paste or ointment to protect the skin. Protectants: are first line therapy and can be used for protection (anticipated during antibiotic therapy) or treatment.  Provides physical barrier to protect skin against irritants and moisture.  Also provides lubrication to reduce skin-to diaper friction.

C = clean; Clean area with water—avoid rubbing area. Use a squirt bottle, pat and air dry.  If using Baby wipes, they should be free of soaps, dyes, perfume and alcohol.

D = disposable diapers; are best option during an episode of diaper rash, rather than cloth diapers. If using cloth diapers, avoid plastic panties.

E = educate; educate your patients about how to prevent a recurrence of diaper rash

Pharmacologic Measures:

Antifungal agents

  • Characterized by beefy red plaques, with scales and satellite papules & pustules. Pustules are superficial.
  • May use Miconazole and Clotrimazole which are OTC, or Nystatin (Rx-only). Don’t use routinely, only when albicans is suspected.

What not to use:

Talc and cornstarch– not recommended due to potential inhalation by the infant.

OTC Antibiotic ointments: Over-the-counter antibiotic creams or ointments (such as Neosporin or Bacitracin) are not recommended because neomycin and bacitracin cause allergic reactions.

Corticosteroids: Hydrocortisone 1% (otc): can be used for moderate to severe diaper rash, or allergic dermatitis. Can be used for up to 2 weeks maximum. Do NOT use stronger corticosteroids (avoid all RX!!)

Peruvian balsam: Butt Paste (Boudreaux Butt Paste) – contains Zn oxide, Peruvian balsam, boric acid, castor oil and petrolatum.  (FDA cautions that Peruvian balsam may cause skin sensitivities.)

Your Thompson Pharmacist can help you select the best preparations to help prevent diaper rash and heal your baby’s bottom.  Go ahead and ASK…at Thompson Pharmacy it’s all for YOU.