Diaper Dermatitis
Conditions
Brief summary
Diaper dermatitis is one of the most common dermatologic diseases affecting infants and children. The incidence is highest among those 9-12 months old and it has been reported to affect 7-50% of infants in the US. It is caused by skin exposure to a combination of several factors including: excessive moisture, topical irritants, reduced pH, friction, maceration and bacterial infection. When infants soil their diaper, diaper contents saturate the area raising the pH of the skin above the normal level of 5 or less, and leaving the area highly vulnerable to maceration from friction. Irritants in urine and feces are then able to penetrate the macerated skin, causing inflammation and greater skin friability. An elevation in the skin pH allows pathogenic bacteria to overgrow, and combined with the breakdown in the skin's outer epithelial barrier, can lead to bacterial infection. Theraworx Foam Formulation-Allantoin Liquid by Avadim Technologies, Inc. is a skin protectant with use for temporary protection of minor cuts, scrapes, burns and chapped or cracked skin. As such, Theraworx Foam used in the diaper area may be beneficial for protecting skin against diaper rash wounds, as well as for assisting with wound healing and reducing any associated pain. The purpose of this study is to determine caregivers' perceptions of the benefits of using Theraworx Foam on their infant's diaper area as part of their hygienic routine, including whether they feel the product is pleasant and easy to use, and whether they feel it helps prevent and reduce the severity of diaper dermatitis in their infants 1-14 months old.
Interventions
DRUGDiaper care with Theraworx
Theraworx foam formulation to be used as a preventive and treatment agent for diaper rashes
Sponsors
Avadim Technologies, Inc.
Linda Fu
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Read English at the 8th grade level * Have reliable access to email for 7 weeks * Complete the first online survey within 24 hours of the request * Custodial guardian of an infant between the ages of 1-12 months old living with him/her, wearing diapers, and has had ≥1 diaper rash in the 2 months preceding recruitment
Exclusion criteria
* Does not have a stable address at which to receive a package of Theraworx and is unable/unwilling to pick it up at Children's National Health System * Infant is immunocompromised, has a congenital disorder, or on the day of recruitment, has a diaper rash, has a moderate to severe illness requiring hospitalization or transfer to the emergency room, or was circumcised \<10 days prior.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Caregiver's Self-report of Prevention of Diaper Dermatitis in Infant | 4 weeks | Caregivers self-report on a weekly basis the total number of days during the past week that their infant had a diaper rash. Diaper rash was defined as the presence of one or more of the following in the diaper region: redness, skin breakdown, papules or pustules. The total number of days with diaper rash for the entire 4 week period was summed from the 4 weekly surveys (outcome measure range: 0-28 days with fewer days representing a better outcome). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Caregiver's Self-report of Diaper Rash Severity | 4 weeks | Caregivers used a modified Diaper Dermatitis Scale (Buckley, et al, Pediatric Dermatology 2016) to report infant diaper rash severity. The scale ranged from 0 (none) to 6 (most severe) with higher scores indicating a worse outcome. Items on the scale included assessments of rash size (0-2), redness (0-1), evidence of skin breakdown (0-1), evidence of papules (0-1) and evidence of pustules (0-1). Mean score was calculated using scores for every day over 28 days. |
Countries
United States
Participant flow
Pre-assignment details
All participants completed routine diaper care during the run-in period, followed by diaper care with Theraworx during the experimental period.
Participants by arm
| Arm | Count |
|---|---|
| Routine Diaper Care Followed by Diaper Care With Theraworx Participants continue their typical diaper care for 4 weeks followed immediately by 4 weeks of using Theraworx Spray Foam, an FDA-registered OTC drug (NDC 61594-000). During this second period, particpants apply a thin layer to their infant's entire diaper area with every diaper change (2-4 foam pumps or 4-6 sprays depending on the infant's size) for 4 weeks.
Diaper care with Theraworx: Theraworx foam formulation to be used as a preventive and treatment agent for diaper rashes | 5 |
| Total | 5 |
Baseline characteristics
| Characteristic | Routine Diaper Care Followed by Diaper Care With Theraworx |
|---|---|
| Age, Continuous | 7 months |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 5 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Frequency of diaper rash in last 30 days, continuous | 7 days |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 0 Participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 5 | 0 / 5 |
| other Total, other adverse events | 0 / 5 | 0 / 5 |
| serious Total, serious adverse events | 0 / 5 | 0 / 5 |
Outcome results
Primary
Caregiver's Self-report of Prevention of Diaper Dermatitis in Infant
Caregivers self-report on a weekly basis the total number of days during the past week that their infant had a diaper rash. Diaper rash was defined as the presence of one or more of the following in the diaper region: redness, skin breakdown, papules or pustules. The total number of days with diaper rash for the entire 4 week period was summed from the 4 weekly surveys (outcome measure range: 0-28 days with fewer days representing a better outcome).
Time frame: 4 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Routine Diaper Care Followed by Diaper Care With Theraworx | Caregiver's Self-report of Prevention of Diaper Dermatitis in Infant | Routine Diaper Care | 3.7 days | Standard Deviation 2.5 |
| Routine Diaper Care Followed by Diaper Care With Theraworx | Caregiver's Self-report of Prevention of Diaper Dermatitis in Infant | Diaper care with Theraworx | 1.7 days | Standard Deviation 1.5 |
Secondary
Caregiver's Self-report of Diaper Rash Severity
Caregivers used a modified Diaper Dermatitis Scale (Buckley, et al, Pediatric Dermatology 2016) to report infant diaper rash severity. The scale ranged from 0 (none) to 6 (most severe) with higher scores indicating a worse outcome. Items on the scale included assessments of rash size (0-2), redness (0-1), evidence of skin breakdown (0-1), evidence of papules (0-1) and evidence of pustules (0-1). Mean score was calculated using scores for every day over 28 days.
Time frame: 4 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Routine Diaper Care Followed by Diaper Care With Theraworx | Caregiver's Self-report of Diaper Rash Severity | Routine Diaper Care | 4.45 score on a scale | Standard Deviation 3.35 |
| Routine Diaper Care Followed by Diaper Care With Theraworx | Caregiver's Self-report of Diaper Rash Severity | Diaper Care with Theraworx | 3.15 score on a scale | Standard Deviation 3.82 |