Candida Diaper Dermatitis

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

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II. Course

  1. Rash starts in perianal area and spreads contiguously

III. Signs

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

IV. Differential Diagnosis

  1. Irritant Diaper Dermatitis
  2. Perianal Streptococcal Dermatitis
  3. Impetigo
  4. 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)
  5. Pediatric Seborrheic Dermatitis
    1. Typically associated with Cradle Cap
  6. 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
  7. Rare, refractory cases
    1. Zinc Deficiency
    2. Hand-Schuller-Christian Syndrome (Histiocytosis X)

V. Management

  1. 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)
  2. Topical Antifungal
    1. Superior cure rates
      1. Miconazole
      2. Clotrimazole
    2. Other agents
      1. Ketoconazole
      2. Nystatin
      3. Amphotericin
  3. Oral Antifungal and Thrush agents
    1. Consider to treat dermatitis and GI Infection
  4. Consider Burow's Solution compresses before Antifungal
  5. For severe inflammatory reaction
    1. Mix Topical Corticosteroid with Antifungal 50:50 or
    2. Alternate applications of Antifungal and steroid

VI. Reference

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Hoppe (1997) Pediatr Infect Dis 16:885-94 [PubMed]

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