That Stubborn Diaper Rash

I often hear in the pediatric world, “I just can’t get this diaper rash to go away.” It can be so frustrating! We are going to discuss some methods to tackle that stubborn diaper rash.

A diaper rash, a type of irritant contact dermatitis, can also be known as diaper dermatitis or incontinence-associated dermatitis. Maybe this problem has never been an issue for you, but maybe it’s been the struggle of the month.

Diaper rashes are the most common skin issue in infants.⁶ As an infant’s gut matures and develops, their stools can go through waves of constipation and diarrhea. A common time when this happens is when an infant begins solids. Other life changes like starting child care, travelling, and teething can alter a baby’s gut and skin integrity. Certain medical conditions, like Crohn’s disease, can also lead to chronic diaper rash.

What causes a diaper rash?

If you remember from biology or chemistry, the body’s pH level is very important and functions in a narrow window. The pH scale operates between 0-14. A lower pH indicates a more acidic environment, while a higher pH indicates a more alkaline environment. The window for the baby/adult skin is 4.5 to 5.5. Newborn infants tend to have a higher pH between 6.34 to 7.5, which occurs due to amniotic fluid exposure.¹These levels slowly start to decrease about a month or so after birth.

Urine and stool make the environment more alkaline (increase the pH), which causes permeability of the skin. Other factors that contribute to this process are excess moisture from incontinence, and shearing forces from wearing a diaper.

As the change in acidity, moisture, and friction act concurrently, this leads to skin inflammation and breakdown. Small skin tears can occur as well.

Medical conditions and other factors that can increase the risk for diaper rash:

Conditions:
- Hirschsprung’s disease
- Short bowel syndrome
- Neurological diseases (spina bifida, cerebral palsy)
  - Certain neurological diseases can affect a child’s ability to control their bladder/bowel or mobility (in medicine this can be described as non-ambulatory), which can lead to their inability to feel the urge to pee/poop. They may also be unable to physically move to a toilet. Therefore, they are unable to use the restroom on their own and need to be in briefs/diapers.
- Crohn’s disease
- Eczema
- Others
Antibiotic use
Infrequent diaper changes
Teething
Other life changes (traveling, starting daycare)

What does a diaper rash look like?

Found on the buttocks, genitalia, abdomen, and legs
Symmetric redness
Minimal swelling of the skin
Increased infant discomfort and irritability
Small scattered wounds, usually around the anus
Bleeding
If there is yeast overgrowth, small scattered red bumps will appear around and within the rash, skin peeling
- Worse in hot environments
More severe disease can have thicker nodules called pseudoverrucous nodules and papules (PPN)

Professional labeled diaper rash severity diagram

What other conditions mimic a diaper rash?

Atopic dermatitis (eczema)
- Typically not present in the buttocks. This condition is fueled by dry skin, so the buttocks are usually spared.
Psoriasis
- Thick, red-silver scale in the groin or diaper area, but usually not symmetrical
Allergic contact dermatitis
- Rash that has been defined borders, that takes a particular shape of where the allergen was placed on the skin (i.e. diapers with fragrances, chemicals)
Infantile seborrheic dermatitis, cradle cap but in the buttocks and groin
- Bright red rash scattered past just the buttocks – to the abdomen, legs, lower back, face, neck, and scalp
- Fine, yellow scale
Scabies
- Scabies are small mites that burrow in the skin
- Usually found in the groin, but also in the armpits and on the belly
- Small red bumps
Pressure ulcers
- Infants and children with neurological disorders (as highlighted above) are at an increased risk of PU. Sometimes PU can mimic a mild diaper rash if one area (buttock, tailbone region) appears to be red. However, redness from a PU will be what we call non-blanchable. This means that if you press on the area of redness (with a finger for 1 second), the skin will not turn white upon release. If it is just a rash, the skin will turn white after pressure release.
- Typically a PU is present with a deeper red or purple hue. Usually these occur in one small area rather than symmetrically appear across the buttocks.

What are some ways to treat it?

Reflecting on how diaper rash occurs in the first place, let’s dive into how we can prevent/treat it. If a diaper rash occurs when the skin integrity of the buttocks becomes compromised, then the key is to protect the skin or regain its integrity by giving the skin a chance to heal.

Preventative: If your child is prone to diaper rashes, or they are about to do something new (start daycare, begin solids, travel, etc.), it could be helpful to begin.
- Ensure wipes and cleansers are pH neutral
- Topical moisturizers (i.e., unscented lotions, petroleum jelly, zinc cream)
- Skin barrier films: very good at preventing rashes, used as a step in more severe diaper rashes, think of these as an extra layer of skin
- Dimethicone

Mild:
- Zinc cream (15-40%)
  - There are many types of zinc creams (i.e. see some on our products page – Babo botanicals or Remedy)
    - Most come in a tube, but some can come in a spray form (easier to apply quickly without the mess)
    - Can be combined with petroleum jelly, lanolin, CMC, or beeswax
    - There is not one superior brand to another. Although some can contain more irritating products (essential oils and fragrances, parabens (end with “paraben” at the end of a word), and dyes). Some work better than others, depending on your baby’s skin.
- Stoma or baby powder
- Zinc cream and stoma powder can be used together
- Zinc cream does not need to be removed with every diaper change. Only remove soiled zinc cream. Can cleanse all of the zinc cream off daily if desired.
- Consistency is key to preventing worsening diaper rash²

Moderate:
- For moderate to severe diaper rash, a common technique called the crusting method is used. It is most often recommended in hospitals by wound specialists. Think of this method like a layered cake.
  - Steps:
    - 1. Apply a baby or stoma powder to the skin
    - 2. “Lock-in” or seal the powder by using a skin barrier film. Gently pat the skin barrier film on, otherwise you will rub off the powder. Allow the film to completely dry. It will turn a white-ish color over the powder. Do not blow on it to dry, this can spread germs.
    - 3. Apply a thick layer of zinc cream (i.e. see some on our products page – Babo botanicals or Remedy)
    - 4. Apply a top layer of baby or stoma powder
  - Ideally, the crusted layers stay in place for 24 hours. With every diaper change, only the zinc cream and topical powder are replaced
  - Cleanse off the layers each day in the bath to avoid rubbing the skin.
- If there is concern for a yeast rash with a moderate to severe diaper rash, substitute an antifungal cream (i.e. miconazole, nystatin) instead of a zinc cream in the crusted layer formula.

Severe:
- Consider making homemade wipes. You can do this by buying soft paper towels, tearing them into individual pieces, and placing them in a gallon-sized bag. Fill the bag with a little bit of filtered or distilled water. Seal the bag, and use it with each diaper change.
- The skin can also be cleansed with hypochlorous acid, which is gentle and sting-free. This is a non-toxic solution that effectively kills bacteria and fungi. It has a bleach-like smell but is not cytotoxic (kills healthy cells) or harmful to the skin. For reference, Hypochlorous acid is used in babies as young as 21 weeks gestation (in the NICU).³
- The crusting method – extra layers
  - Steps:
    - 1. Apply a small amount of a liquid wound dressing to the small open wounds only (i.e., coloplast triad cream with CMC and zinc)
    - 2. Apply a baby or stoma powder to the skin
    - 3. “Lock-in” or seal the powder by using a skin barrier film. Gently pat the skin barrier film on, otherwise you will rub off the powder. Allow the film to completely dry. It will turn a white-ish color over the powder. Do not blow on it to dry, as this can spread germs.
    - 4. With more severe rash, repeat these steps 1-2 more times for 2-3 total layers
    - 5. Apply a thick layer of zinc cream (i.e. see some on our products page – Babo botanicals or Remedy)
    - 6. Apply a top layer of baby or stoma powder
  - Ideally, the crusted layers stay in place for 24 hours. With every diaper change, only the zinc cream and topical powder are replaced
  - Cleanse off the layers each day in the bath to avoid rubbing the skin.
- Ensure these steps are done consistently to treat the rash. Once the rash has improved, do not stop preventative care if diarrhea persists. Consider placing at least a zinc cream or skin barrier to avoid restarting the diaper rash cycle.
- If the crusted layers do not work, there are cyanoacrylate films (turn purple on the skin after drying), such as Marathon. These films harden and provide a protective “extra layer of skin.” The film will eventually crack or peel off.
  - Apply after using hypochlorous acid²
  - The downside of these films is that they are typically very expensive and hard to find, even through a hospital or durable medical supply company (DME)
- If there is concern for a yeast rash with a moderate to severe diaper rash, substitute an antifungal cream instead of a zinc cream in the crusted layer formula.

Some other products and tips:
- Petroleum jelly (i.e., vaseline, aquaphor) can be helpful for skin breakdown. However, it can occlude leftover stool and urine on the skin if applied over top.
- Cholestyramine is a prescription-only cream compounded with petroleum jelly to help remove bile-salts from the skin (found in stool).
  - Mixed success rates
- Compounded creams that include a steroid (triamcinolone, hydrocortisone, betamethasone)
  - Although steroid creams can help reduce inflammation, they can impair wound healing.
  - DO NOT use these on areas of skin breakdown or open wounds
  - Cannot be used for longer than two weeks at a time.
- Leaving the skin open to air if possible (on a chuck pad if bed-bound)
- Dry using small portable fans over the area prior to applying creams or layers
- Frequent diaper changes
  - Some diaper brands will wick away moisture better than others. (i.e. I buy Parasol from Target)
  - I have found that some brands have more chemicals, which are irritating to the skin.
- Breastfed babies have a reduced risk of diaper rash⁵

The DO-NOTs:
- Apply steroid creams on an open wound unless advised by a physician to do so
- Allow for powders to be inhaled by your baby or yourself
- Rub harshly on the skin with wipes
- Cleanse with hydrogen peroxide (delays wound healing) or scented soaps
- Blow on the skin to dry it

Complications

Yeast rash
- Treated with topical antifungal creams or powders
  - Miconazole, clotrimazole, and nystatin (Rx only)
- If there is concern for a yeast rash with a moderate to severe diaper rash, substitute an antifungal cream instead of a zinc cream in the crusted layer formula.
Bacterial superinfection
- Staphylococcus aureus or Streptococcus species (impetigo)
  - Typically treated with topical Mupirocin 2% ointment
- Pseudomonas – can have a strong, foul odor
- Herpes Simplex Virus (HSV)

Summary

Diaper rashes are no fun (for the baby or the parent!)! But they are treatable. Prevention and consistency are essential to successful treatment of these rashes.

Post in the comments below your favorite tips and tricks for diaper rash!

Hope that stubborn diaper rash goes away soon!

The PA Sisters

This post contains affiliate links. As Amazon Associates, we earn from qualifying purchases at no extra cost to you. The PA Sisters are licensed Physician Assistants in the state of Texas, but all content on this blog is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Product recommendations reflect our personal opinions only and do not establish a provider-patient relationship. Always consult your own licensed healthcare provider before purchasing or using any health-related product. Read our full Medical Disclaimer and Disclosure Policy.

References

Oranges T, Dini V, Romanelli M. Skin Physiology of the Neonate and Infant: Clinical Implications. Adv Wound Care (New Rochelle). 2015;4(10):587-595. doi:10.1089/wound.2015.0642
WoundSource. Do you know the basics of incontinence-associated dermatitis treatment and prevention? WoundSource. Accessed September 9, 2026. https://www.woundsource.com/blog/do-you-know-basics-incontinence-associated-dermatitis-treatment-and-prevention
Amaya R, Heisler E. Cutaneous safety evaluation of pure hypochlorous acid solution in preterm infants and neonates with complex wounds. Wounds. 2026 Apr;38(4):84-89.
https://www.uptodate.com/contents/diaper-dermatitis?search=diaper%20rash&source=search_result&selectedTitle=1~51&usage_type=default&display_rank=1&searchCorrelationId=d47febba-c7cc-4092-8c51-d8542fb451b8&searchCorrelationTerm=diaper%20rash
Benitez Ojeda AB, Mendez MD. Diaper Dermatitis. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.
Kurdi A, Aljohani R, Aljohani B, Tharwat T, Alquwayzani D, Alahmadi R. Pseudoverrucous Papules and Nodules in the Perianal Area: A Case Report. Cureus. 2025;17(4):e81945. Published 2025 Apr 9.