II. Course
- Rash starts in perianal area and spreads contiguously
III. Signs
IV. Differential Diagnosis
- Irritant Diaper Dermatitis
- Perianal Streptococcal Dermatitis
- Impetigo
-
Contact Dermatitis
- Found on convex surfaces (contrast with candida which is found in skin folds)
- Apply thick layer of barrier cream (e.g. Zinc Oxide cream)
-
Pediatric Seborrheic Dermatitis
- Typically associated with Cradle Cap
-
Congenital Candidiasis (rare, age <1 week)
- Onset at birth or in the first week of life
- Contrast with typical Candida Diaper Dermatitis which has onset AFTER the first week of life
- Rare, but serious infection with risk of disseminated candidemia (8 to 40% mortality)
- Diffuse erythematous, desquamating maculopapular or papulopustular dermatitis
- Typically spares the diaper region
- Diagnosis with a Potassium Hydroxide preparation (KOH prep) showing pseudohyphae or spores
- Early systemic Antifungals prevents progression to disseminated candidemia
- Onset at birth or in the first week of life
- Rare, refractory cases
- Zinc Deficiency
- Hand-Schuller-Christian Syndrome (Histiocytosis X)
V. Management
-
General
- Keep diaper area dry
- Keep diaper off as much as possible to aerate area
- Zinc Oxide paste
- Soothing and protective after the acute phase
- Baby powder
- May help to dry area (Risk of aspiration)
-
Topical Antifungal
- Superior cure rates
- Other agents
- Ketoconazole
- Nystatin
- Amphotericin
- Oral Antifungal and Thrush agents
- Consider to treat dermatitis and GI Infection
- Consider Burow's Solution compresses before Antifungal
- For severe inflammatory reaction
- Mix Topical Corticosteroid with Antifungal 50:50 or
- Alternate applications of Antifungal and steroid
VI. Reference
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- Hoppe (1997) Pediatr Infect Dis 16:885-94 [PubMed]