Diaper Dermatitis: Microbiome Influence and Best Treatment Strategies

Diaper dermatitis is one of the most common dermatologic conditions in infants, with a multifactorial etiology influenced by mechanical friction, prolonged moisture exposure, altered skin pH, and microbial colonization. Recent advances in microbiome research have expanded understanding of the skin’s microbial ecosystem in early life, highlighting its role in both the pathogenesis and prevention of diaper dermatitis. The infant skin microbiome, shaped by delivery mode, feeding practices, and environmental exposures, plays a pivotal role in skin barrier maturation and immune development. Perturbations to this microbiome, including pathogen overgrowth and reduced commensal diversity, can impair barrier function and promote inflammation. Evidence suggests that targeted interventions particularly early emollient use, topical natural oils, and optimized hygiene may modulate microbial composition, enhance barrier integrity, and reduce dermatitis incidence. Preventive strategies that incorporate microbiome-supportive care, including skin-to-skin contact and emollient therapy in high-risk infants, are supported by emerging randomized controlled trials and mechanistic studies. However, data remain heterogeneous, with differences in study design, population characteristics, and intervention protocols complicating direct comparisons. The integration of microbiome-focused care into standard pediatric dermatology may represent a paradigm shift in diaper dermatitis prevention and treatment. Future research should prioritize longitudinal microbiome analyses, standardized clinical endpoints, and evaluation of combined barrier and microbiome-targeted therapies.