Dose:    Apply thin layer topically

Frequency:  Q 8 hours topically

Comments: Zinc oxide is contained in a number of preparations used to treat sore bottoms (diaper dermatitis).   After a review process undertaken by Kelly Burch, PharmD, several recommendations have been assembled about the care of newborn bottoms. Our concern is to use inexpensive, topical barriers to prevent serious skin breakdown. The overriding concern is to prevent serious skin breakdown by identifying infants most likely to develop problems. Infants who are on oral antibiotics, phototherapy, and/or feeds are at highest risk. Cisapride therapy may predispose an infant to skin breakdown by changing either the frequency of characteristics of stool. Frequent application of either plain white petrolatum or zinc oxide (i.e., A and D ointment, Aquaphor, and/or Eucerin cream) are effective preventative measures. 
    Treatment of established skin breakdown requires a product with a drying ingredient (talc, starch) and an oil base to act as a barrier. Topical vitamins A and D have not been shown to provide additional benefit, although they do not generally add to cost of therapy. Current products used in this situation included Desitin (available generically as Diaper Rash Ointment), Diaper-Derm, and extemporaneously prepared compounds such as Dr. Danis’ Buttocks Cream. Comparisons of these products may be made based on the characteristics of the products as well as costs. Desitin is the least expensive of the three products, but has a distinct odor and has been described by many nurses as difficult to remove. Dr. Danis’ cream is effective and easy to remove, but is the most costly of the alternative, and is not easily available to parents after discharge from the hospital. Overall, Diaper-Derm may be the best alternative since it has many of the desirable characteristics and is available over-the-counter.
    Finally, there are complex cases of perianal skin breakdown in infants with short gut syndrome, liver disease, or both. Sucralfate cream is a compounded product which is intended to bind to denuded skin surfaces, providing a protective layer. It is removed easily if contaminated. It is comparable in cost to Dr. Danis’ cream, and is available only by prescription at Mercy Pharmacy on an outpatient basis. Recently, cholestyramine cream has been suggested in circumstances where bile acids are suspected as a problem. However, it is limited in terms of convenience, availability, and cost.

Toxicity: None reported.

Preparation: Desitin contains 40% zinc oxide, cod liver oil and talc in petrolatum and lanolin base. Available in 30 gram tube. Stable at room temperature.

To prepare Dr. Danis’ Buttocks Cream use:

ZnO 32 grams
Starch 32 grams
Talc 32 grams
Glycerin 60 ml
Aquaphor 112 grams
Lanolin 30 grams

Mix powders, then make a paste with the glycerin. Add the Aquaphor. Then add the lanolin. Dispense 1 ounce per order.  Stable at room temperature.