Peds

Candida Diaper Dermatitis

Candida Diaper Dermatitis, Monilial Rash, Neonatal Candidiasis, Diaper Candidiasis, Napkin Candidiasis

Erythematous confluent Plaque (beefy red lesions affect skin creases)
1. Papules
2. Vesiculopustules
Scalloped border with sharply demarcated edge
Satellite lesions at a distance from primary eruption

Irritant Diaper Dermatitis
Perianal Streptococcal Dermatitis
Impetigo
Contact Dermatitis
1. Found on convex surfaces (contrast with candida which is found in skin folds)
2. Apply thick layer of barrier cream (e.g. Zinc Oxide cream)
Pediatric Seborrheic Dermatitis
1. Typically associated with Cradle Cap
Congenital Candidiasis (rare, age <1 week)
1. Onset at birth or in the first week of life
  1. Contrast with typical Candida Diaper Dermatitis which has onset AFTER the first week of life
2. Rare, but serious infection with risk of disseminated candidemia (8 to 40% mortality)
3. Diffuse erythematous, desquamating maculopapular or papulopustular dermatitis
  1. Typically spares the diaper region
4. Diagnosis with a Potassium Hydroxide preparation (KOH prep) showing pseudohyphae or spores
5. Early systemic Antifungals prevents progression to disseminated candidemia
Rare, refractory cases
1. Zinc Deficiency
2. Hand-Schuller-Christian Syndrome (Histiocytosis X)

General
1. Keep diaper area dry
2. Keep diaper off as much as possible to aerate area
3. Zinc Oxide paste
  1. Soothing and protective after the acute phase
4. Baby powder
  1. May help to dry area (Risk of aspiration)
Topical Antifungal
1. Superior cure rates
  1. Miconazole
  2. Clotrimazole
2. Other agents
  1. Ketoconazole
  2. Nystatin
  3. Amphotericin
Oral Antifungal and Thrush agents
1. Consider to treat dermatitis and GI Infection
Consider Burow's Solution compresses before Antifungal
For severe inflammatory reaction
1. Mix Topical Corticosteroid with Antifungal 50:50 or
2. Alternate applications of Antifungal and steroid