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Diaper dermatitis is often a persistent compromise of the skin barrier. It may appear to be resolved, but compromise remains at the microscopic level. The presence of minor skin compromise increases the likelihood of further injury.
Treatment strategies aim to minimize or eliminate the contributing factors and to detect compromise early. A treatment algorithm is shown in the figure.
Once skin compromise is observed, the presence of infection must be determined. Rash due to candida albicans is characterized by bright red color, patchy pattern (areas may be surrounded by scales) and pustules.
Treatment with anti-fungal agents is indicated. Specific treatment for bacterial dermatitis is based on the causative agent. The treatment goal is to facilitate healing and minimize further irritation.
Recovery of skin barrier compromise occurs more rapidly with films, barriers or creams that are semipermeable to water vapor transport rather than with systems that are completely occlusive or completely open to air.
Reduction of diaper skin moisture is an essential component of treatment. The negative effects of moisture can be minimized with frequent diaper changes, especially in the newborn period. Some clinicians recommend changing the diaper every two to four hours.
Next, minimize chemical and mechanical irritants from urine, feces, products and cleansing practices. The skin should be cleansed as soon as possible after soiling.
Optimum cleansing systems:
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