How to diagnose and manage irritant diaper dermatitis?

Diaper dermatitis^1,2

The condition typically resolves with conservative management.
Each episode is self-limiting with a mean duration per episode of 2 to 3 days.
The condition is cured once the child is fully toilet trained and discontinues the use of diapers.
It is an irritant contact dermatitis secondary to impairment of the normal skin barrier due to the presence of moisture, friction, urine, and feces.

With the advent of superabsorbent gel disposable diapers, the overall incidence of diaper dermatitis has decreased.
Breast-fed infants seem to be less likely to develop moderate to severe diaper dermatitis in comparison to formula-fed infants.³
Pediatricians and family physicians provide more than 90% of physician services for patients with diaper dermatitis.⁴

How to diagnose diaper dermatitis?

The diagnosis of irritant diaper dermatitis is based on clinical findings. If there are erosions, erythematous papules, or pustules present, a workup for an infection should be considered.

How to manage irritant diaper dermatitis?

Management of irritant diaper dermatitis involves gentle cleansing, choice of diapers, and minimizing exposure to potential irritants, such as moisture, friction, urine, and feces.
Once inflammation is present, measures should be taken to calm the inflammation and if present treat any secondary infections.

Prevention and treatment of diaper dermatitis

Barrier preparations that typically contain zinc oxide and petrolatum create a lipid film that penetrates into the stratum corneum to protect the surface of the skin for every diaper change to be effective.^1,6
Dexpanthenol is used topically as an ointment, emulsion, or solution, at concentrations of 2 to 5%, for its antiinflammatory activity.⁵

Self-management strategies¹

Cleansing routine:

• Minimal cleansing after urination
• Gentle rinsing with plain warm water and a small amount of a mild soap or a mild liquid cleanser without water may be used after defecation
• Once cleansed, the area should be gently patted dry as opposed to rubbing and if possible left open to air until completely dry

Diapers:

• When possible, the diaper should be changed immediately after urinating or defecating and can be as frequent as every hour in neonates
• If possible, diaper-free time with exposure to air is needed to completely dry the affected areas

Wipes:

• Using baby wipes for cleansing was found to be equally as mild as using water with no overall change in skin condition¹⁰
• The use of wipes should be discontinued when the skin is broken open