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Diaper dermatitis candidiasis - Anogenital in
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Diaper dermatitis candidiasis - Anogenital in

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Contributors: Romi Bloom MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Candidal diaper dermatitis develops when sufficient moisture in the diaper area allows Candida albicans, normal flora in the mouth and gastrointestinal tract, to proliferate and invade the stratum corneum. The dermatitis usually begins around 6 weeks of age and is often associated with recent antibiotic use or diarrhea, although it can be seen without any inciting factor. It can occur in conjunction with oral thrush. Candida may also secondarily infect and exacerbate irritant diaper dermatitis, seborrheic dermatitis, and flexural psoriasis.

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 topic: Male genital candidiasis

Codes

ICD10CM:
L22 – Diaper dermatitis

SNOMEDCT:
240711004 – Diaper candidiasis

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Diagnostic Pearls

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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 Inverse psoriasis.
  • Diaper irritant contact dermatitis
  • Allergic contact dermatitis
Dermatoses unrelated to the presence of a diaper
  • Acrodermatitis enteropathica (Acquired acrodermatitis enteropathica or Hereditary acrodermatitis enteropathica)
  • Cystic fibrosis
  • Langerhans cell histiocytosis
  • Lichen sclerosus
  • Kawasaki disease
  • Perianal streptococcal infection
  • Late congenital syphilis
  • Male genital candidiasis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:01/21/2019
Last Updated:01/23/2019
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Patient Information for Diaper dermatitis candidiasis - Anogenital in
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Diaper dermatitis candidiasis - Anogenital in
See also in: Overview
A medical illustration showing key findings of Diaper dermatitis candidiasis (Adult) : Confluent configuration, Erythema, Nursing home resident, Scaly plaque
Clinical image of Diaper dermatitis candidiasis - imageId=2026908. Click to open in gallery.
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