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Diaper Rash – What to Do? A Nurse’s Guide to Incontinence-Associated Dermatitis
November 03, 2026
Posted in
ostomy
Kim Hoggard, RN, NSWOC, WOCC(C)
Nurse Specialized in Wound, Ostomy & Continence Care, Founder of NurseCraft
Nurse Specialized in Wound, Ostomy & Continence Care, Founder of NurseCraft
If you are a parent or caregiver, chances are you have encountered diaper rash. It starts by peeling back the diaper to reveal a flaming red bum. You then discover the skin is VERY sore to the touch as you try to clean everything up. More formally known as incontinence-associated dermatitis (IAD), this inflamed skin can make even the kindest person grumpy.
The good news is IAD is very treatable. Most cases are caught early and cared for at home. Where people can get lost is figuring out why the rash is happening and what products to use. Below is a very general overview, to help point you in the right direction. Management usually involves three steps; Assess, Cleanse & Treat. If you would like additional help and support, a Nurse Specialized in Wounds, Ostomy & Continence (NSWOC) can assist with care, management & product selection.
What causes IAD?
Prolonged contact with urine and stool. Urine alters the skin’s natural protective acid mantle while feces contain enzymes which can be corrosive, especially in liquid feces.
Symptoms
Presents as red, sore patches. Often described as a “burning pain.” In extreme cases the skin can breakdown causing erosions which weep serous fluid (shallow wound). Typically located wherever the moisture was in contact such as the groin, buttocks and backs of thighs.
Assess
Train yourself or others within the care team to recognize IAD and complete regular skin checks after episodes of incontinence. Understanding the cause is important for management & prevention. For example, you may notice IAD only occurs during episodes of diarrhea, or that certain types of products used are not effective in preventing IAD.
Gentle Cleanse
Using a gentle touch & the proper cleansers are key. Only pH-balanced cleansers should be used, avoid soaps or alkaline products as they strip the skin. Medical supply stores will often sell cleansers designed for IAD with added features such as no-rinse and nourishing skin conditioners. Only pat the affected area (do not rub) and only use soft clothes to area (preferably single use).
Manage the Moisture
If possible, a toileting schedule can be implemented. Containment products like diapers & pads should be absorbent, breathable, and properly fitted. It is important to check them on a regular basis and change when soiled.
Treat–Minor IAD
There are many different barrier creams and sprays on the market. The most used and typically more affordable are ointments with petroleum, zinc oxide or dimethicone. Liquid film-forming acrylate sprays or wipes can be used for occasional incontinence.
Treat–Moderate IAD
For more severe cases of IAD, a thick cream with 25-40% zinc can be soothing and effective. These are typically marketed as “maximum strength diaper creams.” It is recommended you speak with a pharmacist or an Incontinence Nurse to select the appropriate product and how to use.
Treat–Severe IAD
It’s time to ask for help. Your doctor or Nurse Continence Advisor should assess for different containment options, nutrition, medications and environmental factors. A physiotherapist may conduct a pelvic floor assessment. In extreme cases a fecal or urinary diversion could be considered.
Still Dealing with Stubborn Skin Irritation?
Most diaper rash and incontinence-associated dermatitis clears up with the right cleansing and treatment routine. But if the skin isn't improving, or you're not sure which products are right for the situation, a one-on-one assessment can help.
NurseCraft, founded by Kim Hoggard, RN, NSWOC, WOCC(C), offers personalized virtual and in-person consultations with Nurses Specialized in Wound, Ostomy & Continence. Their team can help assess the skin, recommend the right cleansers and barrier products, and build a care plan that works for your situation.
Book a NurseCraft Consultation
Not ready to book? Learn more about NurseCraft →
NurseCraft consultations are a paid clinical service billed directly by NurseCraft and are not covered or provided free of charge by CanMedDirect. Please contact NurseCraft directly for current pricing and payment details.
Diaper Rash FAQ
Common questions about diaper rash and incontinence-associated dermatitis (IAD), answered by Kim Hoggard, RN, NSWOC, WOCC(C).
IAD is the clinical term for diaper rash — inflamed, sore skin caused by prolonged contact with urine and stool. Urine alters the skin's natural protective acid mantle, while enzymes in feces (especially liquid stool) can be corrosive to the skin.
Red, sore patches, often described as a “burning pain,” typically wherever moisture was in contact — the groin, buttocks, and backs of the thighs. In extreme cases, the skin can break down into erosions that weep fluid.
Management usually involves three steps: Assess (recognize IAD and understand what's causing it), Cleanse (use gentle, pH-balanced products and pat rather than rub), and Treat (apply the right barrier product for the severity of the rash).
Only pH-balanced cleansers — avoid soaps or alkaline products, which strip the skin. Pat the area dry rather than rubbing, and use a soft, preferably single-use cloth.
For minor IAD, ointments with petroleum, zinc oxide, or dimethicone are common and affordable, along with film-forming acrylate sprays or wipes for occasional incontinence. For more severe cases, a thick cream with 25–40% zinc (often marketed as a “maximum strength diaper cream”) can help — a pharmacist or incontinence nurse can help select the right product.
For severe IAD, it's time to ask for help. A doctor or Nurse Continence Advisor can assess containment options, nutrition, medications, and environmental factors, and in some cases a physiotherapist or further workup may be needed.
