Evidence-based nursing intervention to reduce skin integrity impairment in children with diaper dermatitis: A systematic review


Published: 20 May 2021
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Diaper dermatitis often occurs in children. In Indonesia, the guidelines for managing this health problem are issued by each hospital in Indonesia, but there are no guidelines for formal prevention and management released by the Indonesian Health Ministry. This study aimed to propose the Air, Barrier, Cleansing, Diapering, Education (ABCDE) approach as an evidence-based independent nursing intervention to prevent and treat impaired skin integrity, particularly diaper dermatitis, in children by nurses. This systematic review was derived from multiple databases using the following keywords: “child,” “diaper dermatitis,” “diaper-free time,” “air,” "barrier,” “cleansing,” “diaper,” and “education.” From these keywords, 393 articles were collected and then filtered using inclusion and exclusion criteria to obtain the final articles to be analyzed. Thirty-one articles passed the criteria. The study found that the ABCDE approach was effective in preventing and treating diaper dermatitis in children. Its indicators of the approach were preventing or decreasing inflammation, repairing damage to the skin, and preventing reoccurrence. Based on the review and analysis of multiple aspects in Indonesia, the authors proposed a modification of the sequence to CBAD-E to implement the approach in Indonesian children. The intervention of the ABCDE approach matches Indonesian children’s situation, and therefore it can be implemented in Indonesia. Accordingly, this recommendation may be useful and feasible to be implemented by nurses in preventing and treating diaper dermatitis in children, thus decreasing its prevalence.


Carr AN, Dewitt T, Cork MJ, et al. Diaper dermatitis prevalence and severity: global perspective on the impact of caregiver behavior. Pediatr Dermatol 2019;37:130–6. DOI: https://doi.org/10.1111/pde.14047

Merrill L. Prevention, treatment, and parent education for diaper dermatitis. Nursing for Women's Health 2015;19:324–37. DOI: https://doi.org/10.1111/1751-486X.12218

Pogačar MŠ, Maver U, Varda NM, Mičetić-Turk D. Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area. Int J Dermatol 2018;57:265–75. DOI: https://doi.org/10.1111/ijd.13748

Tüzün Y, Wolf R, Bağlam S, Engin B. Diaper (napkin) dermatitis: a fold (intertriginous) dermatosis. Clin Dermatol 2015;33:477–82. DOI: https://doi.org/10.1016/j.clindermatol.2015.04.012

Sukhneewat C, Chaiyarit J, Techasatian L. Diaper dermatitis: a survey of risk factors in Thai children aged under 24 months. BMC Dermatology 2019;19. DOI: https://doi.org/10.1186/s12895-019-0089-1

Yaduwanshi D, Kumari C. Frequency and prevalence of nappy rash in indian infant’s population. Int J Pharmaceut Erudition 2012;1:25–32.

Esser M. Diaper dermatitis: what do we do next? Adv Neonat Care 2016;16:S21–5. DOI: https://doi.org/10.1097/ANC.0000000000000316

Sekarani AA, Febriani DA, Wangi NM, et al. Pengetahuan ibu-ibu mengenai diaper rash pada anak usia batita. Jurnal Farmasi Komunitas 2017;4:26–30.

Li CH, Zhu ZH, Dai YH. Diaper dermatitis: a survey of risk factors for children aged 1–24 months in China. J Int Med Res 2012;40:1752–60. DOI: https://doi.org/10.1177/030006051204000514

Shin HT. Diagnosis and management of diaper dermatitis. Pediatr Clin N Am 2014;61:367–82. DOI: https://doi.org/10.1016/j.pcl.2013.11.009

Shee K, Jagtap V. Effect of health teaching on knowledge and practice of postnatal mother admitted in selected hospital regarding using diaper in children to prevent systemic bacterial infection. Int J Health Sci Res 2019;9:95–101.

Esser MS, Johnson TS. An integrative review of clinical characteristics of infants with diaper dermatitis. Adv Neonat Care 2020;20:276–85. DOI: https://doi.org/10.1097/ANC.0000000000000682

Hockenberry MJ, Wilson D. Wong’s nursing care of infants and children. 10th ed. Missouri: Elsevier Mosby; 2015.

Klunk C, Domingues E, Wiss K. An update on diaper dermatitis. Clin Dermatol 2014;32:477–87. DOI: https://doi.org/10.1016/j.clindermatol.2014.02.003

Wesner E, Vassantachart JM, Jacob SE. Art of prevention: the importance of proper diapering practices. Int J Womens Dermatol 2019;5:233–4. DOI: https://doi.org/10.1016/j.ijwd.2019.02.005

Persatuan Dokter Spesialis Kulit dan Kelamin Indonesia. Panduan praktik klinis bagi dokter spesialis kulit dan kelamin di Indonesia [Internet]. Jakarta: Persatuan Dokter Spesialis Kulit dan Kelamin Indonesia; c2017. Available from: https://www.perdoski.id/uploads/original/2017/10/PPKPERDOSKI2017.pdf

Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015;4. DOI: https://doi.org/10.1186/2046-4053-4-1

Amer M, Diab N, Soliman M, Amer A. Neonatal skin care: What should we do? a four-week follow-up randomized controlled trial at Zagazig University Hospitals. Int J Dermatol 2017;56:1198–203. DOI: https://doi.org/10.1111/ijd.13735

Lavender T, Furber C, Campbell M, et al. Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial. BMC Pediatr 2012;12. DOI: https://doi.org/10.1186/1471-2431-12-59

Furber C, Bedwell C, Campbell M, et al. The challenges and realties of diaper area cleansing for parents. JOGNN 2012;41:E13-25. DOI: https://doi.org/10.1111/j.1552-6909.2012.01390.x

Bartels NG, Lünnemann L, Stroux A. Effect of diaper cream and wet wipes on skin barrier properties in infants: a prospective randomized controlled trial. Pediatr Dermato 2014;31:683–91. DOI: https://doi.org/10.1111/pde.12370

Bartels NG, Massoudy L, Scheufele R, et al. Standardized diaper care regimen: a prospective, randomized pilot study on skin barrier function and epidermal IL- 1α in newborns. Pediatr Dermatol 2012;29:270–6. DOI: https://doi.org/10.1111/j.1525-1470.2011.01590.x

Yonezawa K, Haruna M, Matsuzaki M, et al. Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: a randomized controlled trial. J Dermatol 2018;45:24–30. DOI: https://doi.org/10.1111/1346-8138.14080

Gozen D, Caglar S, Bayraktar S, Atici F. Diaper dermatitis care of newborns human breast milk or barrier cream. J Clin Nurs 2014;23:515–23. DOI: https://doi.org/10.1111/jocn.12047

Seifi B, Jalali S, Heidari M. Assessment effect of breast milk on diaper dermatitis. Dermatol Reports 2017;9. DOI: https://doi.org/10.4081/dr.2017.7044

Keshavarz A, Zeinaloo AA, Mahram M, et al. Efficacy of traditional medicine product henna and hydrocortisone on diaper dermatitis in infants. Iran Red Crescent Med J 2016;18. DOI: https://doi.org/10.5812/ircmj.24809

Ariffin NHM, Hasham R. Potential dermatological application on Asian plants. Biotechnol Bioproc E 2016;21:337–54. DOI: https://doi.org/10.1007/s12257-015-0750-4

Evangelista MTP, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol 2014;53:100–8. DOI: https://doi.org/10.1111/ijd.12339

Firmansyah F, Asnaniar WOS, Sudarman S. Pengaruh pemberian virgin coconut oil (VCO) terhadap ruam popok pada bayi. Celebes Health Journal 2019;1:31–9.

Cahyati D, Indriansari A, Kusumaningrum A. Pengaruh virgin coconut oil terhadap ruam popok pada bayi. Jurnal Keperawatan Sriwijaya 2015;2:57–63.

Summers A, Visscher MO, Khatry SK, et al. Impact of sunflower seed oil versus mustard seed oil on skin barrier function in newborns: a community-based, cluster-randomized trial. BMC Pediatr 2019;19. DOI: https://doi.org/10.1186/s12887-019-1871-2

Watti AWW, Alfiyanti D, Purnomo E, Hartini S. Efektivitas minyak kelapa dan minyak zaitun terhadap pencegahan diaper dermatitis pada anak usia 3-24 bulan di RSUD Tugurejo Semarang. (Unpublished Thesis). Semarang: Sekolah Tinggi Ilmu Kesehatan Telogorejo; 2015. Available from: http://garuda.ristekbrin.go.id/documents/detail/318257

Alonso C, Larburu I, Bon E, et al. Efficacy of petrolatum jelly for the prevention of diaper rash: a randomized clinical trial. J Spec Pediatr Nurs 2013;18:123–32. DOI: https://doi.org/10.1111/jspn.12022

Chaithirayanon S, Aroonchit S, Chalermchai T, et al. Comparative study between talcum and zinc oxide cream for the prevention of irritant contact diaper dermatitis in infants. J Med Assoc Thailand 2016;99.

Nourbakhsh SMK, Rouhi-boroujeni H, Kheiri M, et al. Effect of topical application of the cream containing magnesium 2% on treatment of diaper dermatitis and diaper rash in children: a clinical trial study. J Clin Diagn Res. 2016;10:WC04–WC06. DOI: https://doi.org/10.7860/JCDR/2016/14997.7143

Sharifi-Heris Z, Farahani LA, Haghani H, et al. Comparison the effects of topical application of olive and calendula ointments on children’s diaper dermatitis: a triple-blind randomized clinical trial. Dermatol Ther 2018;31. DOI: https://doi.org/10.1111/dth.12731

Mahmoudi M, Adib-hajbaghery M, Mashaiekhi M. Comparing the effects of bentonite & calendula on the improvement of infantile diaper dermatitis: a randomized controlled trial. Indian J Med Res 2015;142:742–6. DOI: https://doi.org/10.4103/0971-5916.174567

Panahi Y, Sharif MR, Sharif A, et al. A randomized comparative trial on the therapeutic efficacy of topical aloe vera and calendula officinalis on diaper dermatitis in children. Sci World J 2012;2012. DOI: https://doi.org/10.1100/2012/810234

Badelbuu SG, Javadzadeh Y, Jabraeili M, et al. Evaluation of the effect of aloe vera ointment with chamomile ointment on severity of children’s diaper: a randomized, double-blind clinical trial. Tabriz University of Medical Science 2018;16:47–51. DOI: https://doi.org/10.5742/MEWFM.2018.93304

Chasanah NF, Umamah F. Perawatan perianal dengan baby oil menurunkan kejadian diaper dermatitis pada neonatus di ruang neonatus RSUD Sidoarjo. Jurnal Ilmiah Kesehatan 2013;6. DOI: https://doi.org/10.33086/jhs.v6i2.39

Ananingsih T, Hasiholan LB, Wahyono EH. Pengaruh kualitas produk, promosi, harga dan saluran distribusi terhadap keputusan pembelian produk johnson and johnson Indonesia. J Manag 2018;4.

Summers A, Visscher MO, Khatry SK, et al. Indicators of skin barrier integrity among newborns massaged with mustard oil in rural Nepal. J Perinatol 2018;38:64–70. DOI: https://doi.org/10.1038/jp.2017.158

Roy S, Mollah AH, Mannan MA, et al. Hazards of wearing diaper among infants. J Bangladesh Coll Physicians Surgeons 2017;35:170–3. DOI: https://doi.org/10.3329/jbcps.v35i4.34736

Yuan C, Takagi R, Yao XQ, et al. Comparison of the effectiveness of new material diapers versus standard diapers for the prevention of diaper rash in Chinese babies: A double-blinded, randomized, controlled, cross-over study. Biomed Res Int 2018;2018. DOI: https://doi.org/10.1155/2018/5874184

O'Connor RJ, Sanchez V, Wang Y, et al. Evaluation of the impact of 2 disposable diapers in the “natural” diaper category on diapered skin condition. Clin Pediatr 2019;58:806–15. DOI: https://doi.org/10.1177/0009922819841136

Gustin J, Gibb R, Maltbie D, et al. The impact of diaper design on mitigating known causes of diaper dermatitis. Pediatr Dermatol 2018;35:792–5. DOI: https://doi.org/10.1111/pde.13680

Sujatni RA, Hartini S, Kusuma MAB. Pengaruh lamanya pemakaian diapers terhadap ruam diapers pada anak diare usia 6-12 bulan di RSUD Tugurejo Semarang. [Unpublished Thesis] Semarang: Stikes Telogorejo; 2013.

Maya KS, Pai SM, D’Souza A. Effectiveness of awareness programme on prevention and management of diaper dermatitis among mothers of children of age 0 to 1 year. Nitte University J Health Sci 2015;5:77–81.

Kusliayana I, Mardiyah S. Uji daya serap diapers anti ruam (diapers rash) modifikasi sabut kelapa (cocosnucifera). J Muhammadiyah Med Lab Thecnol 2019;2:47–55. DOI: https://doi.org/10.30651/jmlt.v2i2.3384

Sari C, Altay N. Effects of providing nursing care with web-based program on maternal self-efficacy and infant health. Public Health Nurs 2020;37:380–92. DOI: https://doi.org/10.1111/phn.12712

Novitasari, P. D., & Wanda, D. (2021). Evidence-based nursing intervention to reduce skin integrity impairment in children with diaper dermatitis: A systematic review. La Pediatria Medica E Chirurgica, 43(s1). https://doi.org/10.4081/pmc.2021.265

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