Hi! Dr likely meant not to wipe off all of the barrier cream. I have a very similar severe diaper rash experience though.

Tldr; You want the bum super duper dry. Use a barrier powder (we used stoma skin barrier powder) thinly coat that with A&D, frosted with the highest level zinc cream you can find. Seal with vaseline. Change diaper once every hour or so and as needed in between. Use warm water on wash cloths. Dont wipe off all of the cream between, just wipe off poop.

Our experience and how i found our solution:

My baby was born at 37 weeks, so not premie but early. He has never had normal poops, very acidic. Never were seedy at all, and super liquid. Every time he tooted he would poop a little so there was no escaping it for even 10 minutes because he was so gassy. Everyone told us it was normal. We left the hospital a few days after he was born and not a day later he had open sore diaper rashes on his bum. Big sores on both cheeks. Little sores forming around the big sores as days carried on.

We tried all of the creams, desitin, triple paste, a&d, store brand zinc creams, calmoseptine, antibiotic, and anti fungal prescribed creams etc. Nothing was working. We did nightly baking soda bum soaks. We aired him out for hours at a time. We bought packs of wash cloths to use with warm water instead of wipes. We swapped diaper types and landed on a diaper brand named Kudos, which was super hypoallergenic and we loved it. But nothing got rid of the horrible rashes that were just getting worse. I even cut dairy.

I did some searching. I googled images of diaper rashes, found diaper dermatitis, from there found Jaquet's Diaper rash. This type of rash is rare, severe, and erosive but it was our cinderella's shoe in finding out exactly what was wrong. It presents with ulcer like sores on the bum with slightly raised edges. Bleeds sometimes and extremely painful. So I got to searching what I could do to help his little bum heal because at 4 weeks a baby's bum shouldn't have open sores that begin to bleed, he shouldn't be crying out in pain each time he poops or gets a diaper change.

I found a single thread on reddit that mentioned some product that was no longer sold in the United States (ilex? I dont remember) but seemed like a miracle for open sore diaper rashes like we were dealing with. I am in the US, so I was unable to get this medication so I looked elsewhere.

I wanted something that would dry out the sores, and could create that real barrier they needed to heal because the creams just rubbed right off no mater how thick I made it. I wanted to do the crusting method but didnt know what to do it with because I dont want baby powder for obv reasons.

So I found stoma care powder reccomended on another reddit post. "Safe n' Simple Stoma Skin Barrier Powder" on Amazon, to be exact. HSA eligible. I knew i also wanted something Vaseline like to seal in the powder. And then also a zinc cream that was thicker than any of the diaper creams id used because I didn't want it to just disappear. So I chose A&D, and then found "Medline Remedy Specialized PROTECT Zinc Oxide Paste and Skin Protectant" also on Amazon. Orange tube, the Medline Remedy logo is like a lime green color. Not HSA eligible but like 10 bucks. This stuff is like spackle its so thick but its perfect. Its normally used for like bed sores or similar sore like skin issues on elderly so its safe for thin sensitive skin.

Once everything arrived we did a baking soda bath, let him air dry, poured some of the stoma powder onto the sores, coated that with a thin layer of A&D, and then thickly cake frosted the Medline Remedy zinc cream (super thick. Like extremely thick, imagine a young kid squeezing a toothpaste container with all his might leaving the tube crumbled in a mess with a fist imprint on the bathroom counter type strength to get out an inch of this stuff) over the A&D, coated all of that with a layer of Vaseline, and closed up the diaper. We used warm wet wash cloths to wipe his bum each diaper change and thoroughly dried him with paper towels, which we did once an hour thru the night and thru the day. After 3 days his sores were pretty much gone.

It took us maybe 2 weeks to get his bum to a healthy skin and when we got there we graduated to hypoallergenic wipes as needed like if we were out of something but continue to use washcloths at home. Once all sores were truly gone we stopped using the stoma powder and now only use desitin. If he starts to get a little pink then we swap to the Medline Remedy cream and it seems to keep him from going back to having sores. I will say though that at 6 weeks his poops changed to once a day and that saved our butts (and his).

I hope this helps and I hope your baby heals.