Diaper rash treatments

The primary goal in the treatment of diaper rash is prevention and is most often accomplished through frequent diaper changes. 

When a diaper rash is already present, repairing the damaged skin, relieving discomfort, and preventing infection are important factors to consider when developing an effective treatment regimen. 

Most mild cases of diaper rash can be resolved with the use of nonpharmacologic therapies. Keeping the diaper area clean and dry by changing diapers as soon as practically possible is highly effective for treatment and prevention.34,35 Other nondrug options include 26,34... 

Protectants are generally applied to the affected area after every diaper change and can be discontinued when the rash resolves. Other available protectants that can be used alone or in combination for the safe and effective treatment of diaper rash include white petrolatum, vitamins A and D, lanolin, and topical cornstarch. Many agents contain a combination of occlusive and protective agents such as Triple Paste and Calmoseptine . 

Diaper rashes lasting longer than 48 to 72 hours are at increased risk for the development of fungal infections. These complications are most frequently caused by Candida albicans and require treatment with a topical antifungal35,36 (Fig. 62-6). 

Nystatin, clotrimazole, and miconazole creams or ointments applied two to four times daily with diaper changes have all shown to be effective in the treatment of candidal diaper rash. Although some of these products are available over the counter, parents and caregivers should be advised to initiate... 

If conventional treatment fails, unresolved diaper rash can also lead to secondary bacterial infections. Staphylococcus aureus and streptococci are the most likely pathogens responsible for these infections and require treatment with systemic antibiotics.3 37 While topical protectants may be used as an adjunct in treatment, suspected bacterial infections should always be referred to a physician for accurate diagnosis and the selection of an appropriate antibacterial regimen.34 Figure 62-7 shows a useful algorithm for the effective treatment of diaper dermatitis. 

Provide patient education about diaper rash etiology, treatment, and prevention ... 

Alternative/Adjunctive treatment Psoriasis, seborrheic dermatitis, severe diaper rash, dishidrosis, nodular prurigo, chronic discoid lupus erythematosus, alopecia areata, lymphocytic infiltration of the skin, mycosis fungoides, and familial benign pemphigus of Hailey-Hailey. 

Treatment of diaper rash in babies Desitin Zinc oxide Lanolin and petrolatum... 

Toxicity may occur after ingestion, injection, application to damaged skin (e.g., abrasion, burns, or diaper rash), lavage, or enema. Severe systemic toxicity is most likely to occur from repeated dermal application to damaged skin this has been reported mainly in the treatment of diaper rash in young children. Symptoms include nausea, vomiting, bloody diarrhea, severe colic, and abdominal pain. There may be restlessness, delirium, headache, tremors, and generalized convulsions usually followed by weakness and coma. There is fever and tachypnea followed by Cheyne-Stokes-type respirations and respiratory arrest. 

The applications of these dosage forms can be used for their physical effects, in that they act as protectants, lubricants, emollients, drying agents, and such. They may also be used for the specific effect of the medicinal agent present. Preparations that are sold over-the-counter (OTC) often must contain a mixture of medicinal substances for the treatment of minor skin infections, itching, burns, diaper rash, insect stings and bites, athlete s foot, corns, calluses, warts, dandruff, acne, psoriasis, eczema, pain, arthritis, and to supply warmth to aching joints. 

Undecylenic acid preparations are used in the treatment of various dermatomycoses, especially tinea pedis. Concentrations of the acid as high as 10%, as well as those of the acid and salt in the compound ointment, may be applied to the skin. The preparations usually are not irritating to tissue, and sensitization is uncommon. In tinea pedis, the infection frequently persists despite intensive treatment and the clinical cure rate is at best 50%. Other agents therefore are preferred. Undecylenic acid preparations also are approved for use in the treatment of diaper rash, tinea cruris, and other minor dermatological conditions. 

Balsam of Peru is used extensively in topical preparations for the treatment of wounds, skin graft healing, indolent ulcers, scabies, diaper rash, hemorrhoids, anal pmritus, bedsores, intertrigo, eczema, and others in hair tonic and antidandruff preparations, feminine hygiene sprays, and as a fixative or fragrance... 

Zinc oxide occurs in nature as the mineral zincite, and can be prepared from zinc metal by vaporization and oxidation. It can also be prepared from franklinite or zinc sulfide. It is a very fine, odorless, amorphous, white or yellowish white powder. Zinc oxide has a mild astringent, protective and antiseptic action, and is usually formulated into ointment, paste or lotion vehicles. It is used widely in the treatment of dry skin and disorders such as acne vulgaris, prickly heat, insect bites, ivy poisioning, diaper rash, seborreha, impetigo, and psoriasis. It is also contained in some simscreens. 

Rashes not responding to typical creams and concurrent nonpharmacologic treatment Rashes extending beyond the diaper region (e.g., upper abdomen or back)... 

Drug formulations Impaired digestion in cystic fibrosis affects about 90% of patients. As soon as pancreatic insufficiency is identified, enzyme supplementation is prescribed, even for breast fed infants. In a prospective, randomized study 40 infants and toddlers were treated with Creon for children, a formulation that contains smaller granules and is administered with a dosing spoon (5000 lipase units per scoop) and Creon 10 000 for 2 weeks each in a crossover design [113 ]. The former was superior in terms of parents preference, but equally effective with regard to fat absorption. Three patients who took Creon for children had treatment-related adverse events abdominal pain, constipation, vomiting, with one withdrawal) compared with one who took Creon 10 000 (severe diaper dermatitis/nappy rash). 

---