A comparative study between local application of 10% zinc oxide to a combination of 10% zinc oxide and tocopherol in  treating infant’s diaper dermatitis

Nikhita Mirle; Aswathy Rajan; Santosh T Soans

doi:10.14238/pi64.2.2024.113-9

Nikhita Mirle
Aswathy Rajan A. J. Institute of Medical Sciences, Mangalore
Santosh T Soans

DOI: https://doi.org/10.14238/pi64.2.2024.113-9

Keywords: diaper dermatitis, tocopherol, zinc oxide, vitamin E

Abstract

Background Tocopherol is known to have an anti-inflammatory effect, thereby reducing erythema, edema, and skin irritation, which are the main pathologies observed in diaper dermatitis.

Objective To compare the effect of local application of a combination of 10% zinc oxide and tocopherol in the treatment of infant diaper dermatitis with plain 10% zinc oxide.

Methods A single-centric, prospective interventional study was conducted in a tertiary care hospital for 18 months where all children aged <1 year newly diagnosed with diaper dermatitis were selected. They were divided into two groups; one group received only 10% zinc oxide, while the other group received a combination of 10% zinc oxide and tocopherol for local application. Patients were assessed for rash dimensions, severity score of diaper dermatitis, and pH of the rash prior to starting treatment and at the end of 5 days. Statistical analysis was done using students paired two-tailed T-test.

Results Out of 115 infants with diaper dermatitis, 88 were included in our study. The decrease in rash dimensions was greater in the study group (P=0.004). A mean diaper dermatitis severity score of 1.96±0.76 cm in the study group was noted on day five of the assessment (P<0.001).

Conclusion The healing process in diaper dermatitis is accelerated when a combination of 10% zinc oxide and tocopherol is used. This study supports the evidence of expediting healing by tocopherol, which can be considered in treatment recommendations for diaper dermatitis.

References

1. Maya KS, Pai SM, D’Souza A. Effectiveness of awareness programme on prevention and management of diaper dermatitis among mothers of children of age 0 to 1 year. J Health Allied Sci NU. 2015; 5:077-81. DOI: https://doi.org/10.1055/s-0040-1703916.
2. Carr AN, DeWitt T, Cork MJ, Eichenfield LF, Fölster?Holst R, Hohl D et al. Diaper dermatitis prevalence and severity: global perspective on the impact of caregiver behavior. Pediatr Dermatol. 2020; 37:130-6. DOI: https://doi.org/10.1111/pde.14047
3. Blume-Peytavi U, Kanti V. Prevention and treatment of diaper dermatitis. Pediatr Dermatol. 2018; 35: s19- s23. DOI: https://doi.org/ 10.1111/pde.13495
4. Hebert AA. A new therapeutic horizon in diaper dermatitis: Novel agents with novel action. Int. J. Women’s Dermatol. 2021 1; 7: 466-70. DOI: https://doi.org/10.1016/j.ijwd.2021.02.003
5. Merrill L. Prevention, treatment and parent education for diaper dermatitis. Nurs Womens Health. 2015;19:324-37. DOI: https://doi.org/10.1111/1751-486X.12218
6. Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014; 61:367-82. DOI: https://doi.org/10.1016/j.pcl.2013.11.009.
7. Atherton DJ. The aetiology and management of irritant diaper dermatitis. J Eur Acad Dermatol Venereol. 2001;15:1-4. DOI: https://doi.org/10.1046/j.0926-9959.2001.00001.x
8. Heimall LM, Storey B, Stellar JJ, Davis KF. Beginning at the bottom: evidence based care of diaper dermatitis. MCN Am J Matern Child Nurs. 2012;37:10-6. DOI: https://doi.org/10.1097/nmc.0b013e31823850ea
9. Wolf R, Wolf D, Tüzün B, Tüzün Y. Diaper dermatitis. Clin Dermatol. 2000; 18:657-60. DOI: https://doi.org/10.1016/s0738-081x(00)00157-7
10. Ibrahim NI, Wong SK, Mohamed IN, Mohamed N, Chin KY, Ima-Nirwana S, et al. Wound healing properties of selected natural products. Int J Environ Res Public Health. 2018; 15:2360. DOI: https://doi.org/10.3390/ijerph15112360
11. Tosin C, Bonaldi A, Dell’orletta L, Sartori R, Biban P. Zinc oxide 30% and tocopherol compared to 10% zinc oxide ointment in the treatment of infant’s diaper dermatitis: A triple blinded controlled randomized trial. Clin Pediatr Dermatol. 2017;3:1-6. DOI: https://doi.org/10.21767/2472-0143.100024
12. Buckley BS, Mantaring JB, Dofitas RB, Lapitan MC, Monteagudo A. A new scale for assessing the severity of uncomplicated diaper dermatitis in infants: development and validation. Pediatr Dermatol. 2016; 33:632-9. DOI: https://doi.org/10.1111/pde.12988
13. Klunk C, Domingues E, Wiss K. An update on diaper dermatitis. Clin Dermatol. 2014; 32:477-87. DOI: https://doi.org/10.1016/j.clindermatol.2014.02.003
14. Gupta AK, Skinner AR. Management of diaper dermatitis. Int J Dermatol. 2004; 43:830-4. DOI: https://doi.org/10.1111/j.1365-4632.2004.02405.x
15. Stamatas GN, Tierney NK. Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014;31:1-7. DOI: https://doi.org/10.1111/pde.12245
16. Keen MA, Hassan I. Vitamin E in dermatology. Indian Dermatol Online J 2016;7:311-5. DOI: https://doi.org/10.4103/2229-5178.185494
17. Sharifi-Heris Z, Farahani LA, Hasanpoor-Azghadi SB. A review study of diaper rash dermatitis treatments. J Client-Centered Nurs Care; 4:1-12. DOI: https://doi.org/10.32598/10.32598/jccnc.2.4.1
18. Danby SG, AlEnezi T, Sultan A, Lavender T, Chittock J, Brown K, et al. Effect of olive and sunflower seed oil on the adult skin barrier: Implications for neonatal skin care. Pediatr Dermatol; 30: 42-50. DOI: https://doi.org/10.1111/j.1525-1470.2012.01865.x
19. Manzoni P, Gomirato G. Effectiveness of topical acetate tocopherol for the prevention and treatment of skin lesions in newborns: a 5 years experience in a 3rd level Italian Neonatal Intensive Care Unit. Minerva Pediatr. 2005; 57:305-11. PMID: 16205616.
20. Ojeda ABB, Mendez MD. Diaper dermatitis. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. [cited 2022 July 15]. Available from: https://www-ncbi-nlm-nih-gov.translate.goog/books/NBK559067/?_x_tr_sl=en&_x_tr_tl=id&_x_tr_hl=id&_x_tr_pto=tc