2026: Diaper Dermatitis, Insect Bites/Stings

What is diaper dermatitis?

Goals of treatment for diaper dermatitis?

-To relieve symptoms

-To rid the patient of the dermatitis

-To prevent secondary infection

-To prevent recurrences.

Treatment Exclusions for diaper dermatitis

-Lesions >7 days

-Lesions after 7 days of appropriate care

-Secondary infection

-Lesions caused by another disease state

-Dermatitis outside of diaper region

-Possibly associated with UTI

-Presence of broken skin

-Onion-skin like presentation or presence of bullae

-Oozing or blood or pus present

-Chronic or frequently occurring lesions

-Presence of constitutional symptoms

-Significant behavioral changes

-Comorbid conditions

Non-Pharm therapies for diaper dermatitis

-Change the diaper frequently

-Flush skin with plain water at diaper changes

-Allow to dry before re-diapering

What are the ABCDEs for diaper dermatitis treatment?

A-Air: allow diaper area skin to air dry frequently, allow diaper-free time

B-Barrier: Apply barrier skin protectant liberally to diaper area with each diaper change to prevent and treat

C-Cleansing: Gently cleanse the diaper area with a soft cloth and warm water or with a baby wipe when stool is present.

D-Diaper: Change the diaper frequently (every 2 hours) and as soon as it is soiled, if possible. (better to use disposable diapers)

E-Education: Educate about nonpharmacologic diaper hygiene practices and pharmacotherapy,

Diaper Dermatitis Therapies

-Zinc Oxide: can be difficult to clean off

-Calamine: Absorptive, antiseptic, antipruritic

-Emollient: Petrolatum

-Corn starch: Absorbent, Warn of inhalation

-Talc: Lubricant, Warn of inhalation

Zinc Oxide Products

-Desitin

-A+D

-Boudreaux's Butt Paste

-Triple Paste

-Honest Company

Presentation of bug bites/stings

Bites or stings present on the patient

Close contact with bugs

Itching/irritation

Treatment Exclusion for Insect Stings

-Hives, excessive swelling, dizziness, weakness, nausea, vomiting, difficulty breathing

-Significant allergic response away from the sting

-Previous sting by bee, wasp, or hornet (need to evaluate possible development of hypersensitivity)

-Previous severe reaction to insect bite

-Personal or family history of significant allergic reaction

-<2 years of age

Treatment Exclusion for Bug Bites

-Hypersensitivity to insect bites, resulting in systemic symptoms or symptoms away from bite area

-<2 years of age

-History of tick bite and systemic effects indicating possible infection

-Suspected spider bite requiring medical attention

-Signs of secondary infection of bite area

Prevention of bug bites

-Cover skin with clothing and cuff clothing around ankles/wrists/neck

-Avoid swamps, dense woods and brush

-Keep pets free of pests

-Remove standing water

-Limit time outside at night

-Use barriers (screens, netting)

-Apply insect repellent

Counseling points of DEET

-Useful vs. mosquitoes, fleas and ticks

-Releases a vapor which discourages insects

-Apply every 4-8 hours

-<30% preferred for children, but do not for use under 2 months of age

-10%-35% for typical adequate adult protection

-Need >20% for tick prevention

-Don't spray on face... put on hands then apply to face

-Do not use under clothing or over cuts/wounds

-Safe in women who are pregnant or breast feeding

-Apply sunscreen first, then DEET

-Wash it off before bed! And wash your clothes!

-May melt plastic...

First line therapy for bug bites/stings

-Topical Anesthetics: benzocaine, pramoxine, benzyl alcohol, lidocaine, dibucaine, phenol

-Reversible nerve blockade-lose sensation

-First-line therapy if no allergy exists

What is the purpose of hydrocortisone 1% for bug bites

Capable of vasoconstriction, thus may reduce inflammation and pruritis

What is the purpose of topical antihistamines for bug bites

-Diphenhydramine (0.5%-2%)

-Anesthetic effect by depressing cutaneous receptors

What is the purpose of topical counterirritants for bug bites

Camphor (0.1%-3%), Menthol (0.1%-1%)

Lower concentrations bites vs. pain treatment

Anesthetic effect by depressing cutaneous receptors

What is the purpose of skin protectants for bug bites

Protect skin, reduce inflammation and irritation