Topical maternal breast milk versus commercial topical products for diaper dermatitis in infants: a systematic review

Background: Diaper dermatitis is common in infancy and can cause discomfort, recurrent skin breakdown and secondary infection. Topical human milk has been proposed as an accessible, low-cost intervention, but evidence for its effectiveness and the nursing contribution to its implementation remains unclear. Methods: A systematic review was conducted according to PRISMA 2020. Six databases were searched for studies published from January 2015 to November 2025 evaluating topical human milk for prevention or treatment of diaper dermatitis in infants. Risk of bias was assessed using RoB 2 and ROBINS-I. Owing to study heterogeneity, findings were synthesised narratively. Results: Five primary studies involving 238 infants met the eligibility criteria: two evaluated prevention and three treatment. Preventive studies suggested reduced occurrence or severity of diaper dermatitis. Treatment studies reported greater erythema resolution or faster recovery with topical human milk alone or combined with zinc oxide. However, methodological limitations and heterogeneity resulted in low-to-very-low certainty evidence. Nursing roles included assessment, caregiver education, intervention delivery, monitoring and evaluation, although these were inconsistently reported. Conclusion: Topical mother’s own milk shows potential as a low-cost adjunct for preventing and treating mild-to-moderate diaper dermatitis. Evidence is insufficient to support replacement of standard care or routine adoption. Robust trials with standardised protocols and explicit evaluation of nursing implementation are required.