Diaper dermatitis


  • Irritant contact dermatitis - the most common skin disorder in infants[1]
  • Caused by presence of urine, feces, moisture, friction → breakdown of skin barrier
  • Breast-feeding associated with lower rates of severe diaper dermatitis[1]

Dermatitis Types

Clinical Features

  • Erythematous, macular and/or papular rash with well demarcated borders
  • More severe disease will also have skin maceration and erosions
  • Candidal rash will include scaling around margins
    • Classic finding is "satellite lesions" in other locations
    • Also examine for oral thrush

Differential Diagnosis

Neonatal Rashes


  • Clinical diagnosis, based on history and physical examination
  • If erosions or pustules → consider infectious work-up


  • Hygiene
    • Air drying
    • Cleansing regimen (gentle cleaning with water; avoid soap)
    • Superabsorbent gel diapers
    • Frequent changing
    • Barrier creams (zinc oxide)
    • Powders (but caution due to risk of aspiration)
  • Topical corticosteroids (if resistant to hygiene measures)[1]
    • Hydrocortisone 2.5% ointment BID over 2 weeks for mild cases
    • Triamcinolone 0.025% ointment BID over 2 weeks for moderate to severe cases [2]
    • Absorption increased due to moisture and diaper (Cushing syndrome has been reported with overuse)
  • Topical sucralfate may also be used[3]
  • Antifungal cream (if suspect candida dermatitis)[1]
    • Nystatin cream 100,000 U/gram TID x10-14d (If using zinc oxide cream, apply after nystatin)
    • Other options include: clotrimazole, ketoconazole, miconazole, oxiconazole, econazole, sertaconazole
      • Miconazole 0.25% cream to affected area with each diaper change x 7 days
      • Econazole 1% cream to affected area BID, continue for 3 days after resolution
  • Antibacterial therapy (if suspect bacterial infection)[1]


  • Discharge

See Also


  1. 1.0 1.1 1.2 1.3 1.4 Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr;61(2):367-82.
  2. https://www.chop.edu/clinical-pathway/atopic-dermatitis-topical-steroid-treatment-recommendations
  3. Markham T, Kennedy F, Collins P. Topical sucralfate for erosive irritant diaper dermatitis. Arch Dermatol. 2000;136(10):1199-1200. doi:10.1001/archderm.136.10.1199