LactFact 148: Breastmilk for Diaper Dermatitis

Key Points

• The podcast reviews a 2026 systematic review (published in the *Journal of Research in Nursing*) comparing topical maternal breast milk with commercial topical products for diaper dermatitis in infants.
• Diaper dermatitis affects an estimated 30–75% of infants worldwide; contributing factors include prolonged moisture, friction, urine/feces contact, elevated skin pH, irritants, and infant skin vulnerability.
• Breast milk is of interest as a topical treatment because it contains bioactive factors that are antimicrobial, anti-inflammatory, immunologic, and growth-promoting—and it is free and accessible, especially where commercial products are costly or unavailable.
• The systematic review included five primary studies (238 infants total; sample sizes 30–62) conducted in Iran, Turkey, Egypt, and the United States; two examined prevention and three examined treatment of established dermatitis.
• Prevention studies suggested breast milk reduced dermatitis prevalence and severity versus routine/standard care, though one relied only on nurse documentation without a validated severity tool.
• Treatment studies found topical breast milk—alone or combined with zinc oxide—was associated with faster and greater rash resolution and reduced severity compared with routine care or zinc oxide alone; one study used the Buckley Diaper Dermatitis Severity Scale.
• Evidence is preliminary and generally low quality; it does not establish superiority of breast milk over commercial products for severe, ulcerative, fungal, or bacterial dermatitis.
• Findings should not be generalized to frozen or donor milk (different bioactive profile); routine diaper care (frequent changes, gentle cleansing, air drying) should continue.
• The host plans to recommend human milk as an adjunct to other helpful products and notes that eliminating certain citrus foods (mango, pineapple, grapes, berries, tomatoes) from the parental diet may help with recalcitrant perianal dermatitis.

Summary

This episode of the "Lactation Fact" podcast, hosted by Dr. Anne Eglash—a board-certified family physician and breastfeeding and lactation medicine specialist at the University of Wisconsin School of Medicine and Public Health—reviews a recent systematic review titled "Topical Maternal Breast Milk versus Commercial Topical Products for Diaper Dermatitis in Infants." The review, first-authored by Rasha Neymar Jabir Kandil and colleagues from Malaysia, was published in the *Journal of Research in Nursing* in 2026. The podcast is produced by the nonprofit IABLE (Institute for the Advancement of Breastfeeding and Lactation Education) and has no commercial funders.

The authors note that diaper dermatitis is extremely common, affecting an estimated 30–75% of infants worldwide regardless of location. Its causes include prolonged moisture exposure, friction, contact with urine and feces, increased skin pH, irritant exposure, and the inherent vulnerability of infant skin. In resource-limited settings, commercial barrier products may be expensive or unavailable, so preventive and therapeutic strategies must be clinically effective, affordable, acceptable, and easy to integrate into daily family routines. Standard approaches include frequent diaper changes, gentle cleansing, avoiding harsh soaps, air drying, and topical products. Human milk has attracted interest because of its healing, antibacterial, and anti-inflammatory bioactive factors, and because it is free and readily accessible to breastfeeding families. However, prior research has shown mixed results, with studies differing in whether they addressed prevention or treatment, application frequency and duration, technique, outcome measures, and comparators (such as zinc oxide, petroleum-based products, routine care, or no treatment).

The systematic review had two aims: to evaluate evidence for topical human milk in preventing diaper dermatitis and in treating it. It included young children with or at risk of diaper dermatitis, with topical human milk applied by a nurse or caregiver, compared against zinc oxide or petroleum-based preparations, routine care, usual hygiene, or no topical treatment. Five primary studies met inclusion criteria, encompassing 238 infants with sample sizes of 30 to 62, conducted in Iran, Turkey, Egypt, and the United States. Two studies addressed prevention: one in a NICU using mothers' own milk at every diaper change found lower documented dermatitis prevalence versus standard care (though based only on nurse documentation without a validated severity instrument), and a community study of 48 infants found lower occurrence and severity with breast milk versus education alone or routine care, using a validated assessment. Three studies addressed treatment of established dermatitis in hospital or primary care settings. One reported greater reduction in lesion number and severity with breast milk versus routine care, with redness fully resolved by day five in 80% of the breast milk group versus 27% of controls. Another found complete redness resolution by day seven in 81% of infants receiving maternal breast milk versus 42% receiving zinc oxide barrier cream, with reduced severity on days three, five, and seven. A third found faster recovery when breast milk was added to 25% zinc oxide compared with zinc oxide alone, using the validated Buckley Diaper Dermatitis Severity Scale.

Overall, topical human milk appeared associated with improvement whether used alone or with zinc oxide, suggesting a theoretical benefit for mild to moderate irritant dermatitis, but the evidence does not establish superiority over commercial products for severe, ulcerative, fungal, or bacterial dermatitis. The host also mentions a randomized controlled trial in infant atopic dermatitis comparing topical human milk with 1% hydrocortisone, which found improvement in both groups without significant difference over 21 days. The authors hypothesize that benefits derive from antimicrobial, anti-inflammatory, immunologic, and growth-promoting bioactive factors, with accessibility as a major advantage for families who cannot afford or obtain commercial products. The host cautions against generalizing findings to frozen or donor milk, since bioactive factors would differ, and recommends continuing routine diaper care. Personally, Dr. Eglash says she had not previously considered using human milk for diaper dermatitis but will now recommend it alongside other helpful products. She also shares a clinical observation that for recalcitrant dermatitis, especially around the anus, parents stopping citrus foods such as mango, pineapple, grapes, berries, and tomatoes can make a significant difference. She closes by encouraging listeners to visit LactEd.org to learn about IABLE's educational projects, courses, handouts, videos, conferences, and webinars, and to consider membership supporting their free projects.