ZINC OXIDE
Place in Therapy
Place in Therapy: Zinc Oxide
Zinc oxide is among the ingredients approved by the Food and Drug Administration (FDA) for the management of diaper dermatitis.<1> Multiple resources indicate that barrier products containing zinc oxide are to be considered first line therapy for both the treatment and the prevention of this dermatological condition.<1-4> In addition to providing a water-impermeable barrier, products containing zinc oxide also demonstrate mild antiseptic and astringent qualities.<2> Furthermore, at higher concentrations of zinc oxide, the topical products are absorptive as well.<2> Despite limited clinical data, the use of zinc oxide has been associated with a significant reduction in the severity of skin erythema and diaper dermatitis, as well as a reduction in transepidermal water loss (TEWL) when compared to control.<5,6> However, since the use of topical barrier ointments and pastes for the treatment of diaper dermatitis is primarily based upon long-standing clinical experience; there are no retrievable randomized controlled trials comparing barrier products to one another.<3> In the absence of definitive clinical data, zinc oxide may be considered preferable to barrier-only products (e.g. petrolatum) for the treatment of diaper dermatitis due to its additional antiseptic, absorptive and astringent properties.
As a result of its impeccable safety profile, zinc oxide can be used long-term for the prevention and treatment of diaper dermatitis in patients of all ages.<1> Creams typically contain a moderate concentration of zinc oxide (e.g. 15%) and are recommended for the ongoing prevention of diaper dermatitis, as they are easy to apply, spread and remove.<2> Conversely, ointments and pastes containing higher concentrations of zinc oxide (e.g. 40%) are preferred for the treatment of diaper dermatitis as they demonstrate enhanced absorptive and astringent properties.<2> In order to avoid sensitizing effects of additives and fragrances, it is recommended that a plain zinc oxide barrier be applied.<1-2> Products containing additional ingredients should only be used if the additives have been evaluated as safe.
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; 2009:675-682.
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. Horii, KA, Prossick, TA. Overview of diaper dermatitis in infants and children. In: Corona, R (Ed), UpToDate, Waltham, MA, 2013.
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. Baldwin, S., Odio, M. R., Haines, S. L., O’Connor, R. J., Englehart, J. S., & Lane, A. T. (2001). Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper. Journal of the European Academy of Dermatology and Venereology, 15(Suppl. 1), 5-11.
6. Wananukul S, Limpongsanuruk W, Singalavanija S, Wisuthsarewong W. Comparison of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from diarrhea: a multicenter study. J Med Assoc Thai. 2006 Oct; 89(10): 1654-8.
Zinc oxide is among the ingredients approved by the Food and Drug Administration (FDA) for the management of diaper dermatitis.<1> Multiple resources indicate that barrier products containing zinc oxide are to be considered first line therapy for both the treatment and the prevention of this dermatological condition.<1-4> In addition to providing a water-impermeable barrier, products containing zinc oxide also demonstrate mild antiseptic and astringent qualities.<2> Furthermore, at higher concentrations of zinc oxide, the topical products are absorptive as well.<2> Despite limited clinical data, the use of zinc oxide has been associated with a significant reduction in the severity of skin erythema and diaper dermatitis, as well as a reduction in transepidermal water loss (TEWL) when compared to control.<5,6> However, since the use of topical barrier ointments and pastes for the treatment of diaper dermatitis is primarily based upon long-standing clinical experience; there are no retrievable randomized controlled trials comparing barrier products to one another.<3> In the absence of definitive clinical data, zinc oxide may be considered preferable to barrier-only products (e.g. petrolatum) for the treatment of diaper dermatitis due to its additional antiseptic, absorptive and astringent properties.
As a result of its impeccable safety profile, zinc oxide can be used long-term for the prevention and treatment of diaper dermatitis in patients of all ages.<1> Creams typically contain a moderate concentration of zinc oxide (e.g. 15%) and are recommended for the ongoing prevention of diaper dermatitis, as they are easy to apply, spread and remove.<2> Conversely, ointments and pastes containing higher concentrations of zinc oxide (e.g. 40%) are preferred for the treatment of diaper dermatitis as they demonstrate enhanced absorptive and astringent properties.<2> In order to avoid sensitizing effects of additives and fragrances, it is recommended that a plain zinc oxide barrier be applied.<1-2> Products containing additional ingredients should only be used if the additives have been evaluated as safe.
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; 2009:675-682.
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. Horii, KA, Prossick, TA. Overview of diaper dermatitis in infants and children. In: Corona, R (Ed), UpToDate, Waltham, MA, 2013.
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. Baldwin, S., Odio, M. R., Haines, S. L., O’Connor, R. J., Englehart, J. S., & Lane, A. T. (2001). Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper. Journal of the European Academy of Dermatology and Venereology, 15(Suppl. 1), 5-11.
6. Wananukul S, Limpongsanuruk W, Singalavanija S, Wisuthsarewong W. Comparison of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from diarrhea: a multicenter study. J Med Assoc Thai. 2006 Oct; 89(10): 1654-8.