Diaper rash cure– revealed!

A diaper rash question from Kelly: “Dr. Roy – My one year old and I are struggling to get rid of a persistent diaper rash. We’ve tried various creams and antifungal meds (both over the counter and prescription). We’re trying to change diapers every 2 hours. Is it possible that some kids are allergic to diaper creams? If so, do you have any suggestions about what else to do or try? Thank you!”

Any child could be allergic to just about any sort of cream, but I can’t say I’ve run into diaper rash cream allergy. If it seems like that might be going on, switch to plain Vaseline (petroleum jelly.) It has just about nothing in it to be allergic (no protein, just fats.)

As for the best overall approach to diaper rash: every pediatrician has their own secrets. We like to pretend that there’s some super-magical formula for getting rid of diaper rash. In truth, there are really only a few simple techniques that work. You can use any of these in combination:

1. Keep the skin cool and dry. Going naked is by far the best “medicine” for diaper rash, and the cutest too. After a diaper change, let Junior scoot around bare for a little while. Maybe not so good for the carpet, but it’s great for the rash.

2. To further keep skin cool, use a COLD hair dryer after changes (never, never use a hot or warm setting.) Bonus: very young babies love the noise.

3. Bland diaper rash creams protect and soothe. There is no reason to pay more for any kind of fancy-pants (get it?) diaper cream—they’re all going to do the same thing, and none are magic. I like generic zinc oxide paste (anywhere from 20-40%). You can buy store brands in big 1 pound tubs. Good brands of zinc oxide are Balmex and Desitin. Plain Vaseline or generic petroleum jelly works well, too. Use this after the cooling-off naked time. Apply a nice thick layer with a gloved hand (use a glove or it’s hard to get it out from under your nails.)

4. You can add a low-potency steroid, like over-the-counter strength hydrocortisone 1% ointment. Use this twice a day instead of the bland cream if a diaper rash seems like it’s irritating or painful. It will help soothe the skin, though it will not really help it heal faster. There is absolutely no need to use any sort of higher-potency steroid on this area of the body. Some doctors prescribe this stuff, and they’re asking for trouble. Stick with OTC strength and you and your baby will be fine.

5. Yeast sometimes appears in a diaper rash, usually on skin that’s been raw and red for more than three days. Also suspect yeast if your child has been on antibiotics. Though yeast can have a characteristic appearance of little satellite red dots outside of the main rash, it doesn’t always look like this. If you’ve got a diaper rash for more than three days or with dotty satellites, add in an anti-yeast cream twice a day. Over-the-counter generic Lotrimin (clotrimazole 1%) works well. Do this in addition to steps 1-3 above, and add step 4 also if the skin is uncomfortably irritated.

For any diaper rash that doesn’t respond to the above, go see your pediatrician. It’s rare, but sometimes a “diaper rash” can be something different from ordinary. Those cases need additional evaluation.

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Tags: baby, diaper rash, skin care

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