Alternate Names: Dermatitis - diaper and Candida; Monilial diaper rash; Candida-associated diaper dermatitis

Causes and Risks:

Diaper rashes caused by infection with Candida species are extremely common in children. Candida is found everywhere in the environment and takes advantage of the warm moist conditions beneath a diaper to cause superficial skin infections.

The infection may begin as an intensely red patch with irregular but sharp boarders. Satellite lesions, smaller red patches just separated from the original patch’s boarder, spread and blend in with the larger patch. The rash may spread to include the entire area covered by the diaper including the scrotum and penis in boys and the labia and vagina in girls.

Prevention:

Prevention is difficult as the Candida organisms are in the environment. Using highly absorbent disposable diapers which keep the skin dry decreases the likelihood of infection. Changing diapers frequently and blow-drying the skin using a hair dryer set on warm (NOT HOT) will remove excess moisture from the superficial layers of skin. In infants that are on table food feeding cultured yogurt may change the type of bacteria in the gut and on the skin which can be helpful in displacing the Candida.

Symptoms:

• rash, bright red patch which enlarges (patch is made up of small papules and vesicopustules)
• satellite lesions, smaller red patches which grow and Colace with the other patches
• scratching by the infant when the diaper is removed
• scrotum may become fiery red and scaly (boys)
• Other
  • the infant may also have oral thrush

Signs and Tests:

The classic appearance of the rash makes diagnosis of candidal diaper dermatitis possible by examination alone. The presence of yeast in a KOH (potassium hydroxide) preparation of skin scrapings is diagnostic.

KOH test (microscopic examination of skin scrapings in KOH) demonstrates the presence of Candida

Treatment:

Topical antifungal skin preparations will clear candidal infections. Some preparations are available as over-the-counter (OTC) creams and ointments.

Some of these antifungals include:

• nystatin (prescription)
• clotrimazole (OTC) (Lotrimin)
• miconazole (OTC)
• ketoconazole (Rx)

Prognosis:

The rash usually responds well to treatment.

Complications:

• secondary infection
• meatal stenosis in boys after repeat infections

If your baby has a diaper rash that doesn’t respond to home treatment, you should have the baby examined by your health care provider.