Petrolatum
Place in Therapy
Place in Therapy: Petrolatum
Barrier bases, such as petrolatum, are considered first-line treatment and prevention for diaper dermatitis.<1-3> Although comparative studies of barrier bases are lacking, petrolatum proves to be a safe and effective option.<1-5> The majority of literature regarding barrier bases are in favour of petrolatum or zinc oxide as the product of choice.<3>
A review of the literature suggests petrolatum is an effective barrier against skin breakdown.<3> It has been shown to prevent diaper dermatitis and skin erythema versus placebo.<3-5> It has also been demonstrated to reduce trans-epidermal water loss, decrease diaper dermatitis severity, and decrease bacterial colonization of axillary skin.<4> Evidence also suggests that it is safe and effective during the first weeks after birth – even in the very premature infant. <4>
Petrolatum is considered a very well-tolerated product.<1-5> Its use is supported by The Association of Women`s Health, Obstetric and Neonatal Nurses guidelines for neonatal skin care, as well it is among the Food and Drug Administration's approved ingredients for the management of diaper dermatitis.<1,3> However, petrolatum may be irritating to the skin in some individuals.2,5 Formulations with preservatives have been associated with rare cases of skin sensitization.5 Since it is purely a water-impermeable base, maceration can result if applied to overhydrated skin.<2> Petrolatum is a mineral derivative which can be irritating to inflamed skin.<3> There is also a concern that increasing skin hydration will increase the risk of bacterial infection and sepsis. However, studies have shown no change in the microbiological flora or a reduction.<4,5>
In conclusion, petrolatum is an inexpensive, purely impermeable barrier base that is effective and safe for the prevention and treatment of diaper dermatitis. However, zinc oxide has the added benefit of being an impermeable yet absorptive base with demonstrated anti-septic and astringent properties. Therefore, relative to zinc oxide, petrolatum is considered second-line in terms of treatment yet is an equally efficacious first-line option for prevention.
References
1. Hagemeier NE. Diaper Dermatitis and Prickly Heat. In: Berardi, RR, Ferreri, SP, Remington, TL, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC;2009:675-688.
2. Sibbald, D. Diaper Dermatitis. In: McLeod PJ, Allen M, Conly J, eds. Patient Self-Care - Helping Your Patients Make Therapeutic Choices. 2nd ed. Ottawa, ON: Canadian Pharmacists Association; 2010: 534-545.
3. Nopper A, Horii K, Sookdeo-Drost S, et al. Topical ointment therapy benefits premature infants. J Pediatr. 1996 May;128(5 Pt 1):660-9.
4. 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 Jan-Feb;37(1):10-6.
5. Lane A, Drost S. Effects of repeated application of emollient cream to premature neonates` skin. Pediatrics. 1993 Sep;92(3):415-9.
Barrier bases, such as petrolatum, are considered first-line treatment and prevention for diaper dermatitis.<1-3> Although comparative studies of barrier bases are lacking, petrolatum proves to be a safe and effective option.<1-5> The majority of literature regarding barrier bases are in favour of petrolatum or zinc oxide as the product of choice.<3>
A review of the literature suggests petrolatum is an effective barrier against skin breakdown.<3> It has been shown to prevent diaper dermatitis and skin erythema versus placebo.<3-5> It has also been demonstrated to reduce trans-epidermal water loss, decrease diaper dermatitis severity, and decrease bacterial colonization of axillary skin.<4> Evidence also suggests that it is safe and effective during the first weeks after birth – even in the very premature infant. <4>
Petrolatum is considered a very well-tolerated product.<1-5> Its use is supported by The Association of Women`s Health, Obstetric and Neonatal Nurses guidelines for neonatal skin care, as well it is among the Food and Drug Administration's approved ingredients for the management of diaper dermatitis.<1,3> However, petrolatum may be irritating to the skin in some individuals.2,5 Formulations with preservatives have been associated with rare cases of skin sensitization.5 Since it is purely a water-impermeable base, maceration can result if applied to overhydrated skin.<2> Petrolatum is a mineral derivative which can be irritating to inflamed skin.<3> There is also a concern that increasing skin hydration will increase the risk of bacterial infection and sepsis. However, studies have shown no change in the microbiological flora or a reduction.<4,5>
In conclusion, petrolatum is an inexpensive, purely impermeable barrier base that is effective and safe for the prevention and treatment of diaper dermatitis. However, zinc oxide has the added benefit of being an impermeable yet absorptive base with demonstrated anti-septic and astringent properties. Therefore, relative to zinc oxide, petrolatum is considered second-line in terms of treatment yet is an equally efficacious first-line option for prevention.
References
1. Hagemeier NE. Diaper Dermatitis and Prickly Heat. In: Berardi, RR, Ferreri, SP, Remington, TL, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC;2009:675-688.
2. Sibbald, D. Diaper Dermatitis. In: McLeod PJ, Allen M, Conly J, eds. Patient Self-Care - Helping Your Patients Make Therapeutic Choices. 2nd ed. Ottawa, ON: Canadian Pharmacists Association; 2010: 534-545.
3. Nopper A, Horii K, Sookdeo-Drost S, et al. Topical ointment therapy benefits premature infants. J Pediatr. 1996 May;128(5 Pt 1):660-9.
4. 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 Jan-Feb;37(1):10-6.
5. Lane A, Drost S. Effects of repeated application of emollient cream to premature neonates` skin. Pediatrics. 1993 Sep;92(3):415-9.