Diaper Rash: What are the possible treatments?

Topical corticosteroids are frequently used to alleviate outbreaks of eczema. These potent anti-inflammatories work by modulating the immune response. Their mechanism of action primarily relies on their ability to interact with intracellular glucocorticoid receptors found in the cytoplasm of skin cells. Once bound to these receptors, the corticosteroids penetrate the nucleus and alter the expression of genes involved in inflammation, particularly those coding for pro-inflammatory cytokines IL-1 and IL-6, which are involved in the onset of redness. In the case of diaper rash, the inflammation is due to repeated mechanical and chemical irritation, coupled with an alteration of the skin barrier. The application of topical corticosteroids can quickly reduce this inflammation.

The primary corticosteroids used to manage diaper rash include hydrocortisone, at 0.2%, 0.5%, or 1%, desonide at 0.05%, triamcinolone at 0.1%, and betamethasone at 0.05% or 1%. However, while these molecules have a good immunosuppressive action, they can also weaken the skin barrier and promote infections. That's why their use should be short, targeted, and under medical supervision. It is generally advised to apply the corticosteroids in a thin layer twice a day for two weeks on the area prone to diaper rash.

If a bacterial infection is suspected, a doctor or pharmacist may advise supplementing the therapy with topical antibiotics, to be used two to three times a day for a maximum of ten days. If there is no improvement, oral antibiotics effective against staphylococci (cephalexin) and streptococci (penicillin-macrolides) are recommended. When the staphylococcus is resistant to penicillin, a treatment based on sulfamethoxazole or clindamycin should be considered. For comprehensive management of diaper rash, it is important to not prematurely discontinue the antibiotic treatment, even in the case of visible improvement, to prevent recurrence of the infection and the selection of resistant strains.

When a fungal infection is suspected, healthcare professionals administer antifungal medications, most commonly nystatin. Nystatin binds to ergosterol, a crucial component of the fungal cell membrane, leading to a potassium leakage which results in their death. Nystatin also impacts the transport capacity of cell membranes through lipid peroxidation. Nystatin-based creams are used several times a day for seven to ten days. The application can be reduced to twice a day when the substance is combined with triamcinolone, one of the corticosteroids mentioned above. Other antifungal medications can combat diaper rash, such as clotrimazole, miconazole nitrate, or ciclopirox.

Another essential in the therapeutic arsenal against diaper rash is creams based on zinc oxide, a compound with almost no solubility in water and anti-inflammatory and regenerative effects. Ointments containing zinc oxide act as a physical barrier to water absorption and, by inhibiting the adhesion and penetration of microorganisms, reduce the risk of infections in cases of diaper rash. In these creams, zinc oxide is often combined with glycerin, as is the case in Eryplast for example, or lanolin, as in Oxyplastine. Another advantage of these ointments: they are not associated with any significant side effects. For a better therapeutic effect, zinc oxide-based creams should be applied after each diaper change.

Finally, in addition to the treatments mentioned above, certain natural solutions effectively soothe the diaper rash.

• Calendula.

  Calendula is a medicinal plant with anti-inflammatory and healing properties that are particularly suited to diaper rash. Thanks to its richness in flavonoids, it is capable of inhibiting the production of pro-inflammatory mediators, such as prostaglandins, thus reducing local inflammation and the characteristic redness of the diaper rash. Furthermore, calendula stimulates fibroplasia, keratinoplasia, and angiogenesis. It thus positively impacts the proliferative phases of the healing process. Generally applied in the form of an oil macerate, calendula helps to soothe the skin while forming a protective barrier against the moisture of diapers and friction.

• Chamomile.

  Chamomile is also renowned for its anti-inflammatory action, particularly due to the terpenes it contains. These molecules modulate the activity of cyclooxygenase and lipoxygenase, thereby reducing the production of inflammatory mediators responsible for redness and burning sensations observed in diaper rash. Thus, chamomile extract is an ally in soothing irritations and strengthening the skin barrier.

• Aloe vera.

  Rich in polysaccharides and hygroscopic amino acids, aloe vera gel is known for its ability to form a moisturizing film on the skin's surface, thereby reducing transepidermal water loss and maintaining an environment conducive to healing. It also contains glucomannan, a compound that upregulates the growth factor of fibroblasts (TGF-β1) and increases their activity, thus accelerating skin regeneration. Additionally, aloe vera gel has an immediate cooling effect that provides a soothing sensation for the skin.

• Sunflower oil.

  Finally, sunflower oil is a significant source of linoleic acid, a fatty acid that plays a key role in rebuilding the skin's hydrolipidic film. In infants suffering from diaper rash, the alteration of the skin barrier leads to increased water loss and greater vulnerability to irritants such as urine and feces. Additionally, sunflower oil has beneficial antibacterial properties to prevent infection in the diaper area in case of diaper rash.

Note : The list above is not exhaustive, as other botanical extracts are recognized for their ability to manage diaper rash.

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• TIERNEY N. & al. Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management. Pediatric Dermatology (2013).

• NIU G. & al. Safety evaluation for ingredients used in baby care products: Consideration of diaper rash. Regulatory Toxicology and Pharmacology (2017).

• HASANPOOR-AZGHADI S. B. & al. A Review Study of Diaper Rash Dermatitis Treatments. Journal of Client-Centered Nursing Care (2018).