Nature’s gift: topical human breast milk versus standard treatments for diaper dermatitis – A frequentist network meta-analysis of randomized controlled trials.

Abstract

Objectives. Diaper dermatitis (DD) is a common inflammatory condition in infants, and its management remains challenging. Topical human breast milk (HBM) has emerged as a natural alternative to standard treatments such as hydrocortisone, barrier creams, and education-only interventions. This study conducted a frequentist network meta-analysis (NMA) of randomized controlled trials (RCTs) to compare the efficacy of topical HBM with conventional therapies in reducing DD severity.
Materials and methods. Following PRISMA guidelines (PROSPERO CRD42025633665), six databases were searched through December 2024 to identify RCTs evaluating HBM versus standard DD treatments. Data extraction and quality assessment were independently performed by multiple reviewers using the Cochrane Risk of Bias 2 tool. A random-effects model was applied to calculate standardized mean differences (SMD) with 95% confidence intervals (CI) for the primary outcome, and treatment rankings were generated.
Results. Four RCTs involving a total of 281 infants were included, evaluating five interventions: HBM, hydrocortisone, barrier cream, education only, and placebo. Topical HBM ranked first in efficacy and significantly reduced DD severity compared with education-only (SMD: –0.62 [95% CI: –1.13 to –0.11]) and placebo (SMD: –1.32 [95% CI: –2.00 to –0.63]). Additionally, hydrocortisone (SMD: –1.32 [95% CI: –2.00 to –0.63]) and barrier cream (SMD: –1.15 [95% CI: –2.00 to –0.30]) showed significant benefits over placebo. Consistency analyses confirmed these findings.
Conclusion. In conclusion, topical HBM is a natural, safe, and cost-effective treatment that significantly reduces DD severity. Further multicenter trials employing standardized methodologies are warranted to confirm these results and elucidate the underlying mechanisms.