DOI: 10.1111/pde.

13495

Pediatric
ORIGINAL ARTICLE Dermatology

Prevention and treatment of diaper dermatitis

Ulrike Blume-Peytavi MD | Varvara Kanti MD

Charite
– Universit€atsmedizin Berlin,

Corporate Member of Freie Universit€at
Berlin, Humboldt-Universit€at zu Berlin, and
Berlin Institute of Health, Department of
Dermatology and Allergy, Clinical Research
Center for Hair and Skin Science, Berlin,
Germany
Correspondence
Ulrike Blume-Peytavi, MD (Univ.-Prof., Dr.
med), Charite
– Universit€atsmedizin Berlin,
Department of Dermatology and Allergy,
Clinical Research Center for Hair and Skin
Science, Berlin, Germany.
Email: ulrike.blume-peytavi@charite.de
Abstract
Diaper dermatitis (DD) is one of the most common skin conditions that infants suf-
fer from and their caregivers manage in the first months post-birth. As such, ques-
tions of effective prevention and treatment of the condition often arise.
Nonmedical skincare practices that support healthy skin barrier function can prevent
DD manifestation or alleviate the condition in many cases. The usage of barrier
emollients and improved diaper technology contributes to keeping moisture and irri-
tants away from an infant’s delicate skin. This paper addresses facts behind com-
monly asked questions from caregivers regarding DD and discusses effective
measures to prevent and treat the condition.

KEYWORDS
diaper dermatitis, diaper rash, diaper technology, infant skin care, neonatal, skin barrier, skin
pH

1 | INTRODUCTION
Diaper dermatitis (DD), also termed napkin dermatitis or diaper rash,
is a non-specific term used to describe inflammatory reactions of the
skin within the diaper area.1 The word “diaper” is included in the
name not because the diaper primarily causes the dermatitis, but
rather because the dermatitis is associated with a combination of
factors within the diapering area, including prolonged overhydration,
friction, and the presence of irritants in urine and feces.1,2 Knowl-
edge of the complex etiology of DD is key to effective prevention
and management. The aim of this article is to address facts behind
commonly asked questions from caregivers regarding DD and to dis-
cuss effective skin care practices and measures to minimize causa-
tive factors, and thus prevent and control the condition.
2 | PREVALENCE AND BURDEN OF DIAPER
DERMATITIS
DD is one of the most common skin conditions in neonates and
infants and can cause discomfort and stress for both infants and
their caregivers.3,4 The reported incidence and prevalence of DD in
current literature and throughout the world varies greatly.5,6 Approx-
imately 50% to 65% of babies will suffer from diaper rash at some
time.7 DD prevalence allegedly reaches its peak at around nine to
twelve months of age.4 DD can range in severity: out of a given pool
of patients with DD, reportedly 58% have a slight rash, 34% a mod-
erate rash and 8% a severe rash.3,4 Seven percent of parents whose
babies have diaper rash visit a primary care physician.
3 | CAUSATIVE FACTORS
The development of DD is multifactorial.3,8,9 Newborn skin exhibits
a cutaneous immaturity and an increased susceptibility toward skin
barrier disruption or percutaneous absorption.10-13 Furthermore, dif-
ferences in skin barrier function and development are observed
between anatomical regions.10,11,14,15 The skin in the diaper area is
predisposed to irritation by the prolonged contact with irritants, such
as urine and feces, as well as by diaper occlusion, which leads to an
increase in hydration and skin pH.11 Overhydration promotes degra-
dation of the “brick and mortar” structure of the stratum corneum,
contributing to impaired barrier function.16 The acid mantle of the
skin plays an important role in the regulation of enzymes responsible
for stratum corneum integrity.17,18 Prolonged exposure to urine and
feces leads to a more alkaline diapered skin pH, resulting in changes
in microbial colonization, activation of fecal protease and lipase
enzymes, and stratum corneum impairment.19 Additionally, friction
against the skin and maceration can lead to a breakdown of the
skin barrier and increased permeability to potential irritant

Pediatric Dermatology. 2018;35:s19–s23. wileyonlinelibrary.com/journal/pde © 2018 Wiley Periodicals, Inc. | 19

s20 | Pediatric BLUME-PEYTAVI AND KANTI
Dermatology
substances.8,16,20 These factors predispose the skin to microbial T A B L E 1 Prevention of diaper dermatitis by elimination of
invasion and inflammation.5 Particularly Candida albicans and bacte- causative factors
ria, such as Staphylococcus aureus, (b-hemolytic) Streptococcus sp., Causative
E. coli, and Bacteroides sp. are commonly associated with DD.20-23 factor Effect Intervention
A variety of factors may facilitate or exacerbate the rash. These Prolonged and Friction ● Frequent diaper
include the frequency of urination and defecation, hygiene practices excessive change
humidity ● Supra-absorbent
and skin cleansing routines, products applied to the skin, type of dia-
diaper
per used, and frequency of diaper changes, diet, medications, and
● Alkaline ● Disruption of pH balance ● Supra-absorbent
gastrointestinal illnesses.8,9,24,25
urine ● Microbial overgrowth diaper
● Feces ● Activation of fecal lipases, ● Cleansing with
endo-genous and exoge- wipes or cotton
4 | PREVENTING DIAPER DERMATITIS nous proteases wool and water
● Skin maceration ● Topical emollient
● Increased permeability ● Education
Clinical studies on the effects of skin care as well as advances in dia-
Cleansing Further skin barrier ● No use of soaps
per technologies, such as upgrades in diaper design, composition,
using soap breakdown and detergents
and performance, have played a key role in improving skin condition and ● Cleansing with
and reducing the frequency and severity of DD over the years.2,16,26 detergents wipes or cotton
The aim of appropriate skin care practices to prevent DD is to wool and water
support skin barrier function, maintain dryness, reduce friction, and ● Topical emollient
limit exposure to irritants, like urine and feces.3,7 Therefore, to pre-
vent DD, it is recommended to change diapers frequently, use dis- formulated for the skin of newborns and infants may be used for
posable, superabsorbent, and breathable diapers instead of cloth bathing,33 as there is clinical evidence to support efficacy of emol-
7,21,27-32
diapers, cleanse gently, and apply protective emollients. lients in improving skin barrier function and preventing DD.35 The
Parent and caregiver education with clear explanation of etiology formulation of the ideal liquid cleansers or emollients should be
of DD, preventive, and treatment measures is key to ensure compli- either pH neutral or acidic, and contain only ingredients approved
ance and adherence.6,32 for babies by regulators, such as the U.S. Food and Drug Administra-
tion or the European Medicines Agency.33

5 | PREVENTION AND MANAGEMENT –

NONMEDICAL SKINCARE PRACTICES
Management of DD is based on two major objectives: acceleration
3
of healing of damaged skin, and prevention of a recurring rash. Key
to preventing and managing DD is knowledge of its etiology and
elimination of causative factors (Table 1).20 Thus, an important factor
in the prevention and treatment of diaper rash is parent education
and support. In most cases, the management of DD involves general
skin care measures (eg, frequent diaper changing, air exposure, gen-
tle cleansing), choice of diapers, and use of topical barrier prepara-
tions.1
European roundtable meeting recommendations on best prac-
tices in infant skin care were recently published, which provide guid-
ance on bathing and cleansing, diaper care, and use of emollients.33
The evidence base and strength of these recommendations was
assigned using the Grading of Recommendations Assessment, Devel-
33,34
opment and Evaluation (GRADE) system.
5.1 | Skin care – bathing and cleansing
Good hygiene is necessary to prevent skin barrier breakdown. New-
born bathing can be performed without harming the infant, provided
basic safety procedures are followed.33 Bathing is preferable to
washing with a cloth. Soap-free liquid cleansers, appropriately
5.2 | Wet wipes
A number of studies in current literature have directly compared the
effect of cotton wool and water versus baby wipes on clinical skin
parameters and skin barrier function.7,13,36,37 Visscher et al com-
pared two diaper wipes with cloth and water (n = 131 neonates in
the neonatal intensive care unit); perineal erythema and transepider-
mal water loss (TEWL) were significantly lower for both wipes com-
pared to cloth and water.36 Garcia Bartels et al compared baby
wipes with cotton wool and water in a study in 44 full-term new-
borns; significantly lower TEWL was found in the buttock area in
the group using baby wipes compared to water. A physiological
course for stratum corneum hydration (SCH) and skin pH in diapered
and non-diapered areas and a comparable skin condition and micro-
bial colonization were observed in both groups.13 In a large random-
ized controlled study in 280 full-term newborns using specially
formulated baby wipes or water and wash cloth, Lavender et al
found no difference in severity of DD and development of skin func-
tional parameters, such as TEWL, SCH, and skin pH, between the
groups.37
Available data suggest that baby wipes do not harm or disturb
physiological skin barrier maturation.7
Currently, a plethora of baby wipes with different formulations is
commercially available. The use of pH buffers in baby wipes, in par-
ticular, is important in order to counteract alkaline urine and to
BLUME-PEYTAVI AND KANTI
maintain the slight acidity of the skin of the diaper area.8,31,33,36-39
Furthermore, wipes should be free of potential irritants such as alco-
hol, non-allergy screened fragrances, essential oils, soap, sub-optimal
33,37
surfactants, and harsh detergents (eg, sodium lauryl sulfate). Pro-
fessionals should be aware of allergic contact dermatitis in children
in relation to substances used in wet wipes, such as the preserva-
tives methylisothiazolinone (MI), methylchloroisothiazolinone (MCI),
bronopol (2-bromo-2-nitropropane-1,3-diol), and iodopropynyl butyl-
carbamate-40,41 As wet wipes could provide an ideal environment
for microbial growth, they should contain appropriate, well-tolerated
preservatives.33
5.3 | Topical use of emollients
Skin care has been shown to influence skin barrier func-
10,12,15,42,43
tion. Barrier emollients in the diaper region are currently
widely used in developed countries for prevention and first-line
treatment for DD.6,8 Barrier creams can protect the diaper area skin
by coating the skin surface and by supplying lipids that can pene-
trate the intercellular spaces of the stratum corneum, thus prevent-
ing exposure to moisture and irritants and contributing to stratum
3,29
corneum repair. Appropriately formulated emollients can be used
to support skin barrier function, provided they are applied in a thin
layer in the diaper region to avoid occlusion and that care is taken
to avoid trapping in the folds, causing dysregulation of evaporation
and microbial colonization.33
At least twice weekly application of emollients should be consid-
ered in healthy baby skin.33 A variety of formulations are available
for this purpose, containing zinc oxide, petrolatum, cod liver oil,
dimethicone, lanolin, dexpanthenol, and Burow solution, a mixture of
6,21,35
aluminium acetate in water.
Furthermore, inclusion of emollients on the topsheet of diapers
27
may help to reduce the incidence of erythema and diaper rash.
5.4 | Diaper technology
Diaper design and performance has improved notably over the past
decades, leading to a decrease in the prevalence and severity of
DD.2,16,44 Utilizing the full range of available diaper technology to
increase absorbance and decrease irritation and leaking could con-
tribute to preventing DD and to managing the condition should it
44
occur.
Superabsorbent polymers, such as cross-linked sodium polyacry-
late, in the diaper core form a gel when they come into contact with
urine, resulting in reduced skin overhydration and friction, and help
2
to normalize skin pH. They have the capacity to absorb many times
35,44,45
their weight in fluid. In a retrospective evaluation of numerous
clinical trials, the frequency of moderate to severe DD has been
shown to have declined by 50% after introduction of these absor-
44
bent gelling materials. In a recent study, Chinese infants wearing
modern disposable diapers were shown to experience fewer sleep
2
disruptions compared with infants wearing cloth diapers.
Pediatric | s21
Dermatology
In addition, modern superabsorbent disposable diapers have fur-
ther characteristics, such as a topsheet to absorb urine and liquid
feces and an acquisition layer immediately below the topsheet to
spread urine laterally and pull it to the superabsorbent core.2,3,8
Outer breathable backsheets consist of microporous membranes,
enabling a moisture vapor flux while preventing leaks and thus
reducing skin overhydration and occlusion.20,44,46 Materials with
increased stretchiness are being used for comfortable fit and
reduced friction.2,3,8
A surface layer of barrier emollient transferred to the skin during
normal diaper wear can prevent skin barrier damage when skin is
exposed to irritants.8,17,47
6 | PREVENTION AND MANAGEMENT –
MEDICAL SKINCARE PRACTICES
Recalcitrant or severe forms of DD require medical attention with
careful evaluation for other causes of irritation in this area, such as
allergic contact dermatitis, fungal or bacterial infection with subse-
quent appropriate treatment.6,7,21,27,29,31
Topical barrier emollients or medications with irritant or allergic
potential (eg, containing non-allergy screened fragrances and preser-
vatives) should be avoided. Products containing boric acid, camphor,
phenol, benzocaine, and salicylates should also be avoided because
of the potential for systemic toxicity and/or methemoglobinemia.1,48
Depending on age of the infant and severity of DD, low to mod-
erate potency corticosteroids can be considered for a very limited
duration in order to reduce the inflammation, irritation, and the asso-
ciated discomfort due to severe persistent dermatitis.1 High potency
corticosteroids should definitely be avoided due to important local
side effects, such as skin atrophy, striae, and tachyphylaxis. In addi-
tion, systemic absorption of potent steroids is enhanced in the folds
and, especially under occlusive conditions, can lead to hypothala-
mus–pituitary–adrenal axis suppression, Cushing’s syndrome, growth
delay, and other side effects in the pediatric patient. Increased skin
surface area to body weight ratio compared with adults is also an
important factor which should be considered for topical application
of medical care.21,49 Parents should be trained in using the appropri-
ate amount per dose and body area using the concept of a fingertip
unit.50 When used appropriately, topical low to moderate potency
steroids for a limited duration are safe and effective and side effects
are generally rare.50 Ideally, topical steroid therapy in the diaper area
should be limited to short courses (maximum of one week) and fol-
lowed by a steroid holiday and continuous use of emollients and fur-
ther preventive measures (see nonmedical skin care practices).21
In case of Candida infection, topical antifungal agents such as
nystatin, clotrimazole, miconazole, ketoconazole, or ciclopirox can be
applied to the diaper area with every diaper change.1,51 Combination
with mild topical corticosteroids may be considered to reduce
inflammation in more severe cases.7 Relapse of DD after treatment
can be related to recolonization from reservoir sites, concomitant
s22 | Pediatric
Dermatology
bacterial infections, and occasionally, resistance to antifungal
agents.1,21
In case of a secondary bacterial infection, topical antimicrobial
peptides or topical or oral antibiotics may be necessary. In localized
and mild forms, treatment with topical mupirocin applied twice a day
for 5-7 days may suffice.1,21 Oral antibiotics are indicated in case of
more severe infections, such as perianal streptococcal dermatitis.1
Topical vitamin A is contained in many preparations available for
the treatment of DD, even though no sufficient evidence exists sup-
porting or refuting the use of topical vitamin A preparations to pre-
vent or treat DD.52 Further randomized controlled trials are required
to determine whether topical vitamin A is efficacious in treating or
preventing diaper dermatitis.52
7 | CONCLUSION
DD is one of the most common skin conditions in neonates and
infants. This condition has a complex and multifactorial etiology.
Interaction of multiple factors, including diaper occlusion, skin macer-
ation, and prolonged contact with irritants leads to skin barrier
breakdown, microbial invasion, and inflammation. Key to preventing
and managing DD is knowledge of its etiology and elimination of
causative factors. The current decreasing incidence and severity of
DD reflect improvements in the design and performance of diapers,
diaper skin care products, and overall awareness about maintaining
infant skin health.
CONFLICT OF INTEREST
Prof. Blume-Peytavi: Honoraria and consultancy fees: Almirall S.A.,
Bayer Consumer Care AG, Follicum, Galderma R&D, HIPP, Johnson
& Johnson, Merz, Pierre Fabre Dermocosmetique, Procter & Gamble,
Vichy Cosmetique Active International. Research grants and clinical
research cooperations: Bayer Consumer Care AG, Engelhardt, Fol-
licum, Galderma R&D, HIPP, Johnson & Johnson, Pierre Fabre Der-
mocosmetique, Procter & Gamble. Dr. Kanti has no conflicts of
interest to disclose at this time.
ORCID
Varvara Kanti http://orcid.org/0000-0002-1784-5961
REFERENCES
1. Sikic Pogacar M, Maver U, Marcun Varda N, et al. Diagnosis and
management of diaper dermatitis in infants with emphasis on skin
microbiota in the diaper area. Int J Dermatol. 2017;57:265-275.
2. van Gysel D, Kenneally D, Hatzopoulos I. Skin care and sustainability
improvements with baby diaper developments. Eur Obstet Gynaecol
Suppl. 2012;7(suppl 1):31-34.
3. Atherton DJ. A review of the pathophysiology, prevention and treat-
ment of irritant diaper dermatitis. Curr Med Res Opin. 2004;20:645-
649.
BLUME-PEYTAVI AND KANTI
4. Jordan WE, Lawson KD, Berg RW, et al. Diaper dermatitis: fre-
quency and severity among a general infant population. Pediatr Der-
matol. 1986;3:198-207.
5. Adalat S, Wall D, Goodyear H. Diaper dermatitis-frequency and con-
tributory factors in hospital attending children. Pediatr Dermatol.
2007;24:483-488.
6. Klunk C, Domingues E, Wiss K. An update on diaper dermatitis. Clin
Dermatol. 2014;32:477-487.
7. Blume-Peytavi U, Hauser M, Lunnemann L, et al. Prevention of dia-
per dermatitis in infants–a literature review. Pediatr Dermatol.
2014;31:413-429.
8. Atherton DJ. Understanding irritant napkin dermatitis. Int J Dermatol.
2016;55(suppl 1):7-9.
9. Merrill L. Prevention, treatment and parent education for diaper der-
matitis. Nurs Womens Health. 2015;19:324-336; quiz 37.
10. Kanti V, Gunther M, Stroux A, et al. Influence of sunflower seed oil
or baby lotion on the skin barrier function of newborns: a pilot
study. J Cosmet Dermatol. 2017;16:500-507.
11. Ludriksone L, Garcia Bartels N, Kanti V, et al. Skin barrier function
in infancy: a systematic review. Arch Dermatol Res. 2014;306:591-
599.
12. Garcia Bartels N, Lunnemann L, Stroux A, et al. Effect of diaper
cream and wet wipes on skin barrier properties in infants: a prospec-
tive randomized controlled trial. Pediatr Dermatol. 2014;31:683-691.
13. Garcia Bartels N, Massoudy L, Scheufele R, et al. Standardized dia-
per care regimen: a prospective, randomized pilot study on skin bar-
rier function and epidermal IL-1alpha in newborns. Pediatr Dermatol.
2012;29:270-276.
14. Kanti V, Bonzel A, Stroux A, et al. Postnatal maturation of skin bar-
rier function in premature infants. Skin Pharmacol Physiol.
2014;27:234-241.
15. Garcia Bartels N, Scheufele R, Prosch F, et al. Effect of standardized
skin care regimens on neonatal skin barrier function in different
body areas. Pediatr Dermatol. 2010;27:1-8.
16. Odio M, Thaman L. Diapering, diaper technology, and diaper area
skin health. Pediatr Dermatol. 2014;31(suppl 1):9-14.
17. Dey S, Kenneally D, Odio M, et al. Modern diaper performance: con-
struction, materials, and safety review. Int J Dermatol. 2016;55(suppl
1):18-20.
18. Hachem JP, Crumrine D, Fluhr J, et al. pH directly regulates epider-
mal permeability barrier homeostasis, and stratum corneum integ-
rity/cohesion. J Invest Dermatol. 2003;121:345-353.
19. Gozen D, Caglar S, Bayraktar S, et al. Diaper dermatitis care of new-
borns human breast milk or barrier cream. J Clin Nurs. 2014;23:515-
523.
20. Bonifaz A, Rojas R, Tirado-Sanchez A, et al. Superficial mycoses
associated with diaper dermatitis. Mycopathologia. 2016;181:671-
679.
21. Gupta AK, Skinner AR. Management of diaper dermatitis. Int J Der-
matol. 2004;43:830-834.
22. Brook I. Microbiology of secondarily infected diaper dermatitis. Int J
Dermatol. 1992;31:700-702.
23. de Wet PM, Rode H, van Dyk A, et al. Perianal candidosis–a com-
parative study with mupirocin and nystatin. Int J Dermatol.
1999;38:618-622.
24. Lawton S. Nappy rash: diagnosis and treatment. J Fam Health Care.
2014;24:36-40.
25. Shin HT. Diagnosis and management of diaper dermatitis. Pediatr
Clin North Am. 2014;61:367-382.
26. Bender JK, Faergemann J, Skold M. Skin health connected to the
use of absorbent hygiene products: a review. Dermatol Ther (Heidelb).
2017;7:319-330.
27. Odio MR, O’Connor RJ, Sarbaugh F, et al. Continuous topical admin-
istration of a petrolatum formulation by a novel disposable diaper. 2.
Effect on skin condition. Dermatology. 2000;200:238-243.
BLUME-PEYTAVI AND KANTI
28. Odio MR, O’Connor RJ, Sarbaugh F, et al. Continuous topical admin-
istration of a petrolatum formulation by a novel disposable diaper. 1.
Effect on skin surface microtopography. Dermatology. 2000;200:232-
237.
29. Scheinfeld N. Diaper dermatitis: a review and brief survey of erup-
tions of the diaper area. Am J Clin Dermatol. 2005;6:273-281.
30. Lin RL, Tinkle LL, Janniger CK. Skin care of the healthy newborn.
Cutis. 2005;75:25-30.
31. Adam R. Skin care of the diaper area. Pediatr Dermatol.
2008;25:427-433.
32. Boiko S. Treatment of diaper dermatitis. Dermatol Clin. 1999;17:235-
240, x.
33. Blume-Peytavi U, Lavender T, Jenerowicz D, et al. Recommendations
from a European roundtable meeting on best practice healthy infant
skin care. Pediatr Dermatol. 2016;33:311-321.
34. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consen-
sus on rating quality of evidence and strength of recommendations.
BMJ. 2008;336:924-926.
35. Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifesta-
tions, prevention, and management. Pediatr Dermatol. 2014;31:1-7.
36. Visscher M, Odio M, Taylor T, et al. Skin care in the NICU patient:
effects of wipes versus cloth and water on stratum corneum integ-
rity. Neonatology. 2009;96:226-234.
37. Lavender T, Furber C, Campbell M, et al. Effect on skin hydration of
using baby wipes to clean the napkin area of newborn babies: asses-
sor-blinded randomised controlled equivalence trial. BMC Pediatr.
2012;12:59.
38. Odio M, Streicher-Scott J, Hansen RC. Disposable baby wipes: effi-
cacy and skin mildness. Dermatol Nurs. 2001;13:107-112, 17-8, 21.
39. Adam R, Schnetz B, Mathey P, et al. Clinical demonstration of skin
mildness and suitability for sensitive infant skin of a new baby wipe.
Pediatr Dermatol. 2009;26:506-513.
40. Chang MW, Nakrani R. Six children with allergic contact dermatitis
to methylisothiazolinone in wet wipes (baby wipes). Pediatrics.
2014;133:e434-e438.
41. Warshaw EM, Aschenbeck KA, Zug KA, et al. Wet wipe allergens:
retrospective analysis from the North American Contact Dermatitis
Group 2011-2014. Dermatitis. 2017;28:64-69.
42. Kanti V, Grande C, Stroux A, et al. Influence of sunflower seed oil
on the skin barrier function of preterm infants: a randomized con-
trolled trial. Dermatology. 2014;229:230-239.
Pediatric | s23
Dermatology
43. Blume-Peytavi U, Garcia Bartels N. Hautpflege im S€auglingsalter –
Zum Einfluss standardisierter Pflegeregime auf die Hautbarrierefunk-
tion. Aktuelle Derm. 2010;36:214-216.
44. Odio M, Friedlander SF. Diaper dermatitis and advances in diaper
technology. Curr Opin Pediatr. 2000;12:342-346.
45. Davis JA, Leyden JJ, Grove GL, et al. Comparison of disposable dia-
pers with fluff absorbent and fluff plus absorbent polymers: effects
on skin hydration, skin pH, and diaper dermatitis. Pediatr Dermatol.
1989;6:102-108.
46. Akin F, Spraker M, Aly R, et al. Effects of breathable disposable dia-
pers: reduced prevalence of Candida and common diaper dermatitis.
Pediatr Dermatol. 2001;18:282-290.
47. Baldwin S, Odio MR, Haines SL, et al. Skin benefits from continuous
topical administration of a zinc oxide/petrolatum formulation by a
novel disposable diaper. J Eur Acad Dermatol Venereol. 2001;15(suppl
1):5-11.
48. Humphrey S, Bergman JN, Au S. Practical management strategies for
diaper dermatitis. Skin Therapy Lett. 2006;11:1-6.
49. Nield LS, Kamat D. Prevention, diagnosis, and management of diaper
dermatitis. Clin Pediatr (Phila). 2007;46:480-486.
50. Bewley A, Dermatology Working Group. Expert consensus: time for
a change in the way we advise our patients to use topical corticos-
teroids. Br J Dermatol. 2008;158:917-920.
51. Blanco D, van Rossem K. A prospective two-year assessment of
miconazole resistance in Candida spp. with repeated treatment with
0.25% miconazole nitrate ointment in neonates and infants with
moderate to severe diaper dermatitis complicated by cutaneous can-
didiasis. Pediatr Dermatol. 2013;30:717-724.
52. Davies MW, Dore AJ, Perissinotto KL. Topical vitamin A, or its
derivatives, for treating and preventing napkin dermatitis in infants.
Cochrane Database Syst Rev. 2005:CD004300.
How to cite this article: Blume-Peytavi U, Kanti V.
Prevention and treatment of diaper dermatitis. Pediatr
Dermatol. 2018;35:s19-s23. https://doi.org/10.1111/
pde.13495