DermHelpCentral

Difficult Diaper Dermatitis

Dr. Julianne Mann, a pediatric dermatologist at the Oregon Health Sciences University, has the following recommendations for recalcitrant diaper dermatitis.

KEEP IT SUPER SIMPLE!

1. Absolutely NO diaper wipes at all.  Have mom get a large pack of rectangular cotton makeup remover pads.  Have her apply mineral oil to the cotton pad and use this to clean the baby's bottom.  When she is away from home OK to have her use a damp cotton cloth (I tell parents to pack several damp soft cotton washcloths in a ziplock in their travel diaper bag).

2. With every diaper change, have mom liberally apply a thick barrier paste after cleaning the baby's bottom.  We have had the best luck with a compounded butt paste that our local pharmacy mixes up because we suspect that preservatives in OTC diaper pastes may also play a role with the dermatitis.  They compound 25% corn starch, 25% zinc oxide, and 50% petrolatum and dispense as a one pound jar.

3. I emphasize the importance of stopping everything else that they've been using.  Most parents whose baby's butt looks like this have been desperately trying everything, including doing things like vinegar or baking soda soaks and trying a different cream almost daily.  I tell them the goal is to simplify.  KEEP IT SUPER SIMPLE!

Before and after photos of an infant with erosive diaper dermatitis (Jacquet’s Disease).  Improvement started within the first week of treatment.

 

 

Diaper Dermatitis

Diaper Dermatitis
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