Doctor Q&A Youtube EczemaBlues Channel

AAD A:Z Videos with Dr Lawrence F. Eichenfield – How to Treat Diaper Rash

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “How to Treat Diaper Rash”. For this video, I interviewed Dr Lawrence F. Eichenfield, M.D., who is the Chief of Pediatric and Adolescent Dermatology of Rady’s Pediatric Eczema Center, and Professor of Pediatrics and Medicine (Dermatology), at the University of California, San Diego (UCSD) School of Medicine. Dr. Eichenfield’s clinical interests include atopic dermatitis, and serves on the editorial boards of several journals and periodicals, and is Co-Editor in Chief of Pediatric Dermatology.

In the video, the key points covered are:

  • Always change the soiled diapers, even if it’s just wet
  • Gently cleanse the bump area, such as using moist cloth or alcohol-free and fragrance-free baby wipes
  • Use diaper cream that is zinc oxide based
  • Watch for signs of infection

MarcieMom: Thank you Dr Lawrence for helping parents to learn more about diaper rash this week (and on eczema bleach bath therapy last week). Although diaper rash is common, we still need to learn the proper care for diaper rash and when it is no longer a rash to be self-treated.

Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash
Questions answered by Dr Lawrence Eichenfield on How to Treat Diaper Rash

I understand that diaper rash is a layman’s term and the rash is most likely to be contact dermatitis, caused by close contact of the baby’s skin with the urine/stool that act as skin irritant.

MarcieMom: Is irritant contact dermatitis the most common form of diaper rash? What are other potential irritants apart from urine/stool? For instance, can the diaper itself irritate?

Dr Lawrence: It is true that irritant contact dermatitis is the most common form of diaper rash, with irritation from urine and stools being the most profound irritants. Occasionally children can get inflamed due to other factors, including allergy to diaper contents, though rare, infections such as yeast, which has occurred commonly after courses of oral antibiotics, and many other less common causes of irritation.

MarcieMom: We know that babies have underdeveloped sweat glands and thus occlusion and sweat can lead to heat rash/ miliaria.

MarcieMom: Is it possible that the diaper rash is a heat rash? What are the other possible diagnosis of diaper rash?

Dr Lawrence: It is uncommon for diaper rash to be “heat rash” as the anatomy of the diaper region is different. Aside irritant and occasionally allergic contact dermatitis, there is a broad set of causes of diaper rash which includes yeast infection, psoriasis, and in unusual cases, a broad set of more serious diseases. There are textbook chapters with long list of potential causes of diaper rash, though fortunately, these are uncommon.

MarcieMom: We saw in the video that cleaning the baby’s bum is part of caring for diaper rash. Many parents clean with baby wipes which may end up irritating the baby’s skin if the wipes contain methylchloroisothiazolinone (MI) or methylisothiazolinone. MI was named 2013 “Allergen of the Year” by the American Contact Dermatitis Society.

MarcieMom: What precautions should parents take when cleaning their baby’s bottom to ensure that the cleaning itself will not further irritate the skin? How can parents tell if it’s their cleaning that cause the rash instead of the contact with the soiled diaper?

Dr Lawrence: Parents may be less concerned now, as standard products have dropped MI or MCI from standard wipes. Parents don’t need to be concerned about potential allergy to their cleaning products if diaper rashes respond quickly to standard cleansing and moisturizing regimens, or even interventions with a few days of diaper cream and/or over-the-counter hydrocortisone. If rashes persist with the use of cleansing products and do not respond to standard treatment, then this may be a different story.

MarcieMom: It is recommended in the video to use a zinc-oxide based diaper cream. The diaper cream can act as a barrier that limits the contact of the urine/stools with the baby’s skin. Again, we want to avoid the situation where the cream itself becomes the source of irritant contact dermatitis or even allergic contact dermatitis (where the skin reacts to allergen in the cream).

MarcieMom: What are the ingredients to avoid when selecting a diaper cream? Apart from the obvious ingredients to avoid such as alcohol and fragrance, can ‘good’ ingredients like vitamin E also trigger a rash? Is it better to stick to a ‘basic’ diaper cream that is mainly zinc oxide, instead of a ‘fancy’ one with more ingredients?

Dr Lawrence: Diaper creams that are zinc-oxide based are a tried and true remedy. These produces a barrier layer that protects the skin and also aids in healing of mild irritation or inflammation. Most commercial products have been tested to be safe, with a tendency to be “bland”, meaning a minimal amount of additives being included in the preparations. Parents should be careful with some “organic-based products”, as these sometimes contain contact sensitizers, meaning chemicals that children can become allergic to.

Thank you Dr Lawrence for helping with the questions – we certainly are more informed about to care for our baby’s diaper rash and not aggravate it.

Doctor Q&A Eczema Tips

Sensitive Skin Product Series – How to Manage the Diaper Area?

I ‘met’ Laura Verallo Rowell Bertotto, the CEO of VMVGroup, on twitter and learnt that her company is the only hypoallergenic brand that validates its hypoallergenicity.

VMV Hypoallergenics is founded in 1979 by Dr. Vermén Verallo-Rowell who is a world renowned dermatologist, dermatopathologist and dermatology/laser surgeon, also an author, esteemed researcher and speaker. 

Sensitive Skin Skincare Product Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics
  1. Sensitive Skin Product Series – What is Hypoallergenic?
  2. What does Natural Skincare Product mean?
  3. What is considered Organic and Non-Comedogenic?
  4. What does Suitable for Eczema Children mean?
  5. What is Patch Testing (for skincare product ingredients?)
  6. How do you read ingredients on skincare product label?
  7. What does Irritant-Free mean?
  8. What ingredients in skincare product to avoid?
  9. How is Coconut Oil used in skincare?
  10. What is product cross-reactivity?
  11. How many ingredients in a skincare product?
  12. How to use skincare products on Sensitive Skin?
  13. How to manage the diaper area?
Grandma Minnie's Oil's Well Nurturing Do-It-Oil (picture from
Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil (picture from

Marcie Mom: I note with interest that your product Grandma Minnie’s Oil’s Well Nurturing Do-It-Oil can prevent diaper rash.

What is the ingredient that prevents this rash and how it is different from the off-the-shelf diaper rash cream?

Dr. Verallo-Rowell: The USDA- certified Organic Virgin Coconut Oil and Monolaurin

Both ingredients – no reported allergies, irritations from either one.

1. Virgin coconut oil prevents the diaper rash by its giving an additional barrier film of protection on top of the skin to help protect the skin from irritating chemicals: urine, feces, sweat, preservatives, possibly antiseptics that may be used by manufacturers of diapers. Paper / tissue products are often preserved, some even with formaldehyde or formaldehyde-like chemicals. In addition, virgin coconut oil under the influence of natural skin bacteria that contain lipases (the same lipase enzymes that break down the sebum/fats produced by our skin glands to produce fatty acids that give the skin is acidity or acid mantle – an innate antiseptic function from the skin) – produce monoglycerides of its lauric, capric and caprylic fatty acids.  These are well studied to have broad-spectrum antiseptic properties.

2. The purified monolaurin produced in the laboratory of Dr. John Kabara wrote and worked on this ingredient since the 1960s… is added for additional protection of the skin.

Laura: Most diaper rash creams primarily contain just zinc oxide and petroleum jelly.

One dermatological (prescriptive) diaper rash ointment contains an antifungal drug (many diaper rashes are actually a fungal condition) and cannot be obtained without a prescription (it also costs around US$300).

We mimic both the effects of the above in Oil’s Well in that the Virgin Coconut Oil provides a bit of the barrier function of zinc oxide and petroleum jelly, and the monolaurin provides an antiseptic, antibiotic and antifungal action.  Note that monolaurin is also present in breast milk as another innate or natural antibiotic provided by nature from breastfeeding infants.

Prevent Diaper Rash

Marcie Mom: For prevention of diaper rash, your recommendation is to apply where the skin comes into contact with wetness. However, for eczema rash, I read that it’s least likely to be where the skin is wet.

Dr. Verallo-Rowell: Need to know the context of this statement because wetting the skin in those with eczema does make the skin more moisturized (water is the best moisturizer) but that wetness must not be chronic to macerate it such as in the diaper and around the mouth areas from saliva, mucus, sweat, food, etc.

Diaper Rash vs Eczema

Marcie Mom: My baby often gets rashes and scratches around the diaper waist band and the upper thigh joint areas. How can a parent differentiate between diaper rash and eczema rash? And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse?

Dr. Verallo-Rowell: Yes. Can be from pressure (a form of dermographism) or actual irritation (rarely at that age, allergy), by the chemicals in the elastic material of the waist and thigh band or even the chemicals in laundry soap.

How can a parent differentiate between diaper rash and eczema rash?  By the presence of the rash in other areas more commonly involved by atopic eczema rash in babies: outer areas of the upper and lower extremities, the face.

And would applying moisturizer on the rash area that’s covered by the diaper makes the rash worse? Yes if the moisturizer has ingredients that are irritating to the skin usually by virtue of its scent, preservatives, antibiotics, dyes, non-medical grade lanolin, etc. Note that vitamin E and tea tree oil, propolis, and some other natural ingredients are top allergens in the allergens list.

Marcie Mom: A BIG THANK YOU to Dr. Verallo-Rowell and Laura for helping us in this series on sensitive skin products. We’ve learnt SO much from you and SO much more confident on how to choose and manage the sensitive skin of our children.