American Academy Of Dermatology: Dermatologists Offer Top Tips For Treating Little Bottoms

While to the untrained eye diaper rash might not seem like something to cry about, those in the know (aka parents) would likely offer a different opinion. That's because the red, sore skin that results from diaper rash can be frustrating to treat and cause considerable discomfort for infants. Fortunately, dermatologists -- physicians who specialize in all aspects of skin care -- can help parents treat this common skin problem.

Speaking today at the 65th Annual Meeting of the American Academy of Dermatology, dermatologist Mary K. Spraker, MD, FAAD, associate professor of dermatology and pediatrics at Emory University in Atlanta, Ga., discussed practical ways to prevent diaper dermatitis and explained how advances in the design of disposable diapers and a new prescription medication are helping to reduce this irritating condition.

There are two common forms of diaper dermatitis -- simple "irritant" diaper dermatitis and candida or "yeast" diaper dermatitis. Irritant diaper dermatitis occurs when feces and fecal enzymes, especially when combined with urine, inflame a baby's delicate skin if they are in contact with it for a significantly long period of time. The best way to prevent this type of diaper rash is to remove a soiled diaper as soon as possible.

"Over the years, there have been considerable improvements in the design of modern disposable diapers and, as a result, severe diaper rash is not as common as it once was," said Dr. Spraker. "Numerous studies have shown that infants who wear today's disposable diapers get fewer diaper rashes than infants who wear traditional cloth diapers."

Dr. Spraker explained that the super-absorbent gel that was added to the core of disposable diapers in the mid-1980s can absorb many times its weight in moisture. This gel also grabs on to the wetness without letting go of it, trapping urine in the center of the diaper and leaving the surface of the diaper that touches the infant's skin nearly completely dry. Since wet, softened skin is less healthy, it is more easily irritated by fecal material and more easily infected by candida. The introduction of this super-absorbent gel marked a significant advancement in preventing diaper rash.

In the 1990s, a breathable membrane similar in design to the popular fabric in hiking and sport outerwear garments that keeps rain out but "breathes" to prevent excess perspiration was added to higher-end disposable diapers. This membrane allows water vapor to escape through the cover of the diaper, which reduces the humidity inside the diaper and keeps the diapered skin drier and healthier.

In addition to using disposable diapers that feature these design improvements, Dr. Spraker recommends the following tips to prevent and treat persistent diaper rash:

-- Promptly change diapers containing stool. Since urine by itself is not irritating, mildly wet diapers do not need to be changed immediately. Industry studies show that most parents change a baby's diaper six to seven times per day on average.

-- Cleanse fecal matter off baby's skin with baby wipes, which are non- irritating.

-- To treat irritant diaper dermatitis, apply a barrier cream that contains zinc oxide or petrolatum. It is not necessary to use a barrier product to prevent a rash.

-- Avoid using unnecessary products, such as powders, on baby's bottom. Baby powder should be avoided, as babies can breathe them in and develop pneumonia.

To treat diaper rash caused by candida, Dr. Spraker advises doctors to prescribe an antifungal cream or ointment. Until recently, there was no antifungal approved by the U.S. Food and Drug Administration (FDA) for treating diaper dermatitis in infants -- as these products had only been studied to treat adults with candida infections. In 2006, the FDA approved a new ointment for treating diaper dermatitis associated with candida that contains 0.25 percent miconazole nitrate in a base of zinc oxide and white petrolatum. This prescription medication contains a lower concentration of the active ingredient miconazole than the amount present in other antifungal topicals formulated for adults (0.25 percent vs. 2 percent, respectively).

"The introduction of this prescription antifungal is a breakthrough, because we finally have a product that is specially formulated for infants," added Dr. Spraker. "In what is probably the largest clinical study ever performed on diaper dermatitis complicated by candidiasis, 330 infants and toddlers were studied. This product was proven to be safe, effective and well tolerated."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails.

American Academy of Dermatology
http://www.aad.org/