By Brian T. Maurer
Brian T. Maurer has practiced general pediatrics as a Physician Assistant for thirty years.
I once heard the late Dr. Sydney Hurwitz (author of Clinical Pediatric Dermatology and a pediatric dermatology professor at Yale) speak to a group of pediatricians on common skin conditions in children. At the time he emphasized that Lotrisone (clotrimazole/ betamethasone diproprionate cream) had absolutely no place in the treatment of diaper rash. He cited a report of a young child who had developed major systemic side effects secondary to
continued applications of Lotrisone to the diaper area. Dr. Hurwitz actually advocated that the drug be banned from use in the pediatric age group for that reason.
Applying such a potent steroid preparation under an occlusive dressing (e.g., the diaper) only enhances the systemic absorption of the drug.
For these reasons, I refrain from using Lotrisone in young children.
In healthy infants with recalcitrant diaper dermatitis, I believe that in most cases the underlying problem is either:
(1) an irritant diaper dermatitis,
(2) a contact diaper dermatitis (from the perfume in the particular brand of disposable diapers—worth inquiring if the parent switched brands at some point), or
(3) perhaps even a reaction to the steroid component of Lotrisone.
When faced with this scenario, I generally advise that parents:
Brian Maurer’s Approach to Diaper Dermatitis
(1) Avoid using disposable wipes (even the hypoallergenic kind). Instead, cleanse the diaper area with a warm wet washcloth, using a mild skin cleanser like Cetaphil if necessary;
(2) Start Aveeno sitz baths 2 to 3 times daily to soothe the area (for more details on Aveeno bath go to pdf below)
(3) Dry the diaper area with a hairdryer on low setting; then
(4) Apply a barrier ointment with each diaper change, such as Vaseline petroleum jelly, Calmoseptine ointment, Balmex ointment, Desitin, or Boudreau’s Butt Paste (you gotta love that name).
(5) Temporary use of cloth diapers without plastic pants may also help.
If all else fails, a mixture of Maalox and cornstarch powder dabbed on to the diaper area with each change usually works to improve the rash in a few days.
Printable Version of Brian Maurer's Protocol: Download Maurer’s Diaper Dermatitis
