Basic Preventive Treatment

The first step in the approach includes increasing the frequency of napkin changes and cleansing the skin. The skin is cleaned gently and nursed with lukewarm tap water without rubbing. If faecal material is still present, a mild soap is used. Parents may use baby wipes [5].

Depending on the severity and care intervention, the napkin rash resolves after improved hygiene or medical treatment. The activating factors must be minimized or eliminated to disrupt the process leading to napkin dermatitis. Medical treatment often consists of simple measures. A barrier cream containing zinc-oxide ointment, titanium dioxide or white soft paraffin, or a water-repellent substance such as dimethicone or other silicones, should be applied. The barrier agent selected should be non-toxic and as cosmetically acceptable as possible. The baby can be bathed once or twice daily with bath oil preparations.

Further Treatment

For napkin dermatitis that is not controlled by improved hygiene and use of emollients or barrier creams, a topical anticandidal drug (such as nystatin or an imidazole) should be used, best combined with 1% hydrocortisone in an ointment base. A barrier ointment should be used regularly, applied liberally at each napkin change.

Corticosteroids

The use of corticosteroids is controversial, but those of low potency such as 1% hydrocortisone acetate are acceptable. It is unnecessary to use a higher potency preparation than 1% hydrocortisone acetate. However, 1% hydrocortisone acetate should only be applied for a short period. Fluorinated and highly potent corticosteroids are contraindicated. Hydrocortisone can reduce the inflammation associated with napkin dermatitis. It should be used not more than twice daily. Corticosteroids have a markedly increased potency on the perineum and buttock areas because of the napkin’s occlusive properties leading to an increased risk of atrophy and striae, and even the possibility of adrenal suppression.

Tar

The use of tar ointments is controversial and conflicting, because of possible carcinogenic potential effects. In some countries in Europe (including The Netherlands) it was common practice to use tar. Regulatory restrictions now limit the preparation of the ointments. Purified coal tar 10% in zinc-oxide ointment is effective, especially when combined with sulphur 5% [2].

Anticandida Treatment

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