Diaper dermatitis candidiasis in Child
See also in: AnogenitalAlerts and Notices
Synopsis
An alkaline pH in the diaper area predisposes a patient to candidal diaper dermatitis. In both children and adults, fecal bacteria further alkalize urinary pH, which increases the risk of candidal infections. Breast-fed infants have a lower incidence of diaper dermatitis than formula-fed infants, which is theorized to be secondary to a lower stool pH in the breast-fed infants. Furthermore, patients with a defective Th17 response are predisposed to recurrent cutaneous candidal infections.
In adults, risk factors for candidal diaper dermatitis include urinary and fecal incontinence, diabetes mellitus, obesity, human immunodeficiency virus (HIV) infection, antibiotic use, systemic immunosuppressive medications including corticosteroids, prolonged hospitalizations, nursing home stays, and bedbound patients.
Related topics: Male genital candidiasis, Vulvovaginal candidiasis
Codes
ICD10CM:L22 – Diaper dermatitis
SNOMEDCT:
240711004 – Diaper candidiasis
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Differential Diagnosis & Pitfalls
The diaper area and distant skin should be examined for signs of other dermatoses. Candida may superinfect any diaper dermatitis that persists longer than 72 hours (especially irritant diaper dermatitis). Therefore, isolated candidal diaper dermatitis should be considered only when other possibly coexistent dermatoses have been ruled out.Other diaper-area dermatoses include the following:
Diaper-induced or exacerbated dermatoses
- Seborrheic dermatitis
- In psoriasis, no satellite lesions are usually seen. Psoriatic lesions are also erythematous and well demarcated but are usually covered in silvery scale outside of moist skin areas such as intertriginous zones. Psoriatic plaques can also be found outside of the diaper. See also flexural psoriasis.
- Irritant diaper dermatitis
- Allergic contact dermatitis
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References
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Last Reviewed:12/26/2018
Last Updated:01/23/2019
Last Updated:01/23/2019
Patient Information for Diaper dermatitis candidiasis in Child
Overview
Candida albicans is a type of fungus normally found in the digestive (gastrointestinal) tract. If your baby is wearing a moist or blocked up (occluded) diaper, particularly one that is dirty (has fecal contamination), an inflammatory skin rash (dermatitis) may develop on the baby's skin. Diarrhea increases the risk for developing candidal diaper dermatitis, and candida infection in the mouth (oral thrush) may also occur.Who’s At Risk
Diaper dermatitis is one of the most common skin conditions in infants and children. Candidal diaper dermatitis is the second most common type of diaper dermatitis, with noninfected areas of redness and tenderness (irritant diaper dermatitis) being the most common type.Signs & Symptoms
- Candidal diaper dermatitis most commonly appears in the genitals and diaper area, particularly the deep folds, and it consists of red elevated areas (papules) and flat, solid areas of skin (plaques) with sharp edges and skin flakes (scale) as well as surrounding "satellite" skin elevations containing pus (pustules).
- Redness (erythema) may appear to be joined into one area (confluent).
- Breakdown (erosions) or loss of the upper layer of skin may be present.
- Alternatively, the lesions may be merging together (coalescing) small pink bumps with overlying scale, without any redness.
Self-Care Guidelines
- Keep the diaper open as much as possible while the infant sleeps to allow drying of the skin.
- Use barrier ointments such as zinc oxide paste or petrolatum (Vaseline) with diaper changes.
- Gently cleanse the diaper area with plain water or mild soap.
- Be sure to change your baby's diapers, using disposable diapers.
When to Seek Medical Care
See your baby's doctor or a dermatologist for evaluation if your baby's diaper dermatitis does not improve with self-care measures.Treatments
Topical therapies, applied twice a day:- Nystatin cream
- Econazole cream
- Miconazole cream
- Clotrimazole cream
References
Bolognia, Jean L., ed. Dermatology, pp.1186. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.1373-1374, 2010-2011. New York: McGraw-Hill, 2003.