Comparative Study between Talcum and Zinc Oxide Cream for the Prevention of Irritant Contact Diaper Dermatitis in Infants
Suthida Chaithirayanon MD**, Sirilak Aroonchit MD*, Thep Chalermchai MD*, Arucha Treesirichod MD**, Montree Udompataikul MD*
Affiliation : * Skin Center, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand ** Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background : Baby powder which consists of talcum powder (magnesium silicate) as an active ingredient has been popularly
used for prevention of irritant contact diaper dermatitis for a long time because it has water absorbent and friction-decreased
properties. There are some case reports of its side effects of pulmonary complication from massive inhalation and the risk of
ovarian tumors in adult. However the clinical research on the effectiveness of talcum powder for the prevention of diaper
dermatitis has not been investigated.
Objective : To compare the effectiveness between talcum powder with topical zinc oxide cream for the prevention of irritant
diaper dermatitis.
Material and Method: Fifty Thai infants at the age of 6-12 months old were randomized. Either topical talcum powder or zinc
oxide cream was topically applied to their skin before changing new diapers. The follow-up were conducted at week 0, 2 and
8 to evaluate an occurrence of diaper dermatitis and to collect the median time-to-event data (the duration of disease
occurrence). The clinical severity was assessed by using diaper dermatitis severity scoring scale and the side effects were
recorded.
Results : The average age of the infants was 8.8 months old. The incidence of irritant contact diaper dermatitis from the talcum
group was 4 per 1,000 persons-day (95% confidence interval, 95% CI: 2-7) while the incidence of diaper dermatitis from the
zinc oxide group was 2 per 1,000 persons-day (95% CI: 1-5). The median time-to-event outcome of diaper dermatitis for the
talcum group was 19 days (interquartile range, IQR: 7-29) which was earlier than that of zinc oxide group, which was 39 days
(IQR: 30-59). This showed statistically significant difference (p = 0.03, Log rank test). The average of disease duration of the
talcum group (mean + SD) was 2.7+0.5 days whereas that of the zinc oxide group was 3.7+3.3 days. There is no significant
difference between the two groups (p = 0.34). Most of the severity of the disease found in both groups is mild. The risk
evaluation of diaper dermatitis at week 8, determined by using Cox proportional hazard analysis showed that the talcum
group had 5.3 times greater risk than the zinc oxide group (hazard ratio, HR; 5.3, 95% confidence interval, CI: 1.4-20.0),
with significant group difference (p = 0.01). There was no adverse effect detected on both groups.
Conclusion : Topical zinc oxide cream was better than talcum powder for the prevention of irritant contact diaper dermatitis.
Keywords : Diaper dermatitis, Zinc oxide cream, Talcum powder
