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1

What is a Diaper Rash?

Acute inflammatory rxn
in the area of skin covered by a diaper

MOST common in infants 9-12 months

Can also occur in adults w/ diapers
for continence issues
SAME as infants

2

What CAUSES diaper rash?

Increased PERMEABILITY
skin hydration / increased pH / fecal enzymes / microorganisms

Compromised Skin -> Diaper Dermatitis
chemical irritants / fecal enzymes / mechanical irritation
C. albicans infection

3

How to PREVENT/Treat Diaper rash

INCREASE diaper changes

INCREASE Bath frequency

Medication + Protectants

4

Risk Factors for DIAPER RASH in infants

+ Complications

Bottle fed (vs breast fed)

Introduction of Solid Foods

CLOTH diapers

Oral Antibiotics
related to risk of diarrhea + secondary infection w/ yeast

Complications
Bacterial overgrowth = Staph/strep --> pustules w/ crusting

Fungal infection = C.Albicans --> RED / satellite lesions

5

EX-ST

for Diaper Rash

Lesions on body OUTSIDE diaper area

>7 days or no improvement after 3-4days treatment

Physiological changes = NVD + Fever
constitutional symptoms = lethargy / behavior changes

BROKEN SKIN
Ulceration / blistering / peeling

SECONDARY infection
pus / oozing lesions / satellite lesions

Comorbid Condition
HIV / organ transplant / immunosupression

6

NON-Pharmacologic Management

of Diaper Rash

Remove source of irritation
"Diaper-Free" time

Frequent Change = >6 times / day

Thoroughly CLEAN + DRY the diaper area after each change

Proper diaper use:
disposables / properly-laundered cloth diapers

7

PROTECTANTS

Pharmacologic Management of Diaper Rash

Various Products + MoA

DECREASE Skin Friction
Non-Powders = protect from contact w/ moisture
Powders = absorb moisture

Allantoin / Calamine / Cocoa Butter / Cod liver oil
Colloidal Oatmeal / Dimethicone / Glycerin / hard fat
Kaolin / Lanolin / Mineral Oil / Petrolatum
Topical CORNSTARCH 
Zinc Acetate/Carbonate/oxide

TALC = acceptable ingredient but is consiered a COSMETIC agent

8

PROTECTANTS
instructions for use

Pharmacologic Management of Diaper Rash

AAA or Area @ Risk
with EVERY diaper change

are should be CLEAN + DRY 
BEFORE application

9

Protectants
Caution + ADR

Pharmacologic Management of Diaper Rash

Generally considered safe, no OD risk

Hydrophobic may be difficult to REMOVE from skin

Powders should be kept away from FACE
 inhalation issue

TALC = should NOT be used on broken/oozing skin

Lanolin may cause contact dermatitis

 

10

Agents to AVOID

Pharmacologic Management of Diaper Rash

Topical Analgesics
CAMPHOR

Antiseptics
Boric Acid / Benzalkonium Chloride / Calcium undecyclenate

AntiMicrobials + AntiFungals
unless recommended by MD

Topical Anti-Inflammatories
Corticosteroids, unless recommended by MD = use LOW potency

 

11

Selecting a PRODUCT

Agents for diaper rash

there are NO contraindicated combinations
many products have >1 apporoved protectants

Review inactive ingredients
to ensure NO undesireble agents

Select agent with LEAST inactive ingredients

Comparable products, let caregiver have preference

12

PHARMacologic Management of

INFECTED Diaper Rash

After DIAGNOSIS of 2ndary fungal infection

Treat w/ OTC antifungal agent:
Miconazole / Clotrimazole

clean / DRY affected area
Apply antifungal to AA BID-TID
do NOT apply with EVERY diaper change!
Apply protectant for interim diaper changes

13

What OTC medication can be used if 

2ndary Fungal Infection was DIAGNOSED by MD?

LOTRIMIN AF
Miconazole or Clotrimazole

Comes in creams / powders / sprays

 

14

PREVENTION of Diaper Rash

Proper Diaper Hygiene = KEY
Frequent change / avoid plastic pants
completely CLEAN + DRY diaper area

Recommend use of Protectants PREVENTITIVELY when
@risk of diaper rash = Antibiotic use / Diarrhea
can be PREVENTED w/ appropriate us

do NOT use antifungals PREVENTATIVELY

15

Desitin

 

PROTECTANT for Diaper Rash

ZINC OXIDE
Paste / Cream / Ointment (petrolatum)

also good for PREVENTION of diaper rash
most important is proper diaper hygiene / changing

See MD if >7days