What is the treatment for candidal (Candida) diaper dermatitis?

From the Guidelines

To treat yeast diaper rash, topical antifungal agents are the preferred treatment option. According to the practice guidelines for the treatment of candidiasis by the Infectious Diseases Society of America 1, in healthy, normal birth weight, term infants, therapy of the primary cutaneous disease with topical agents is generally appropriate.

Key Considerations

• The treatment should focus on applying an antifungal cream containing clotrimazole, miconazole, or nystatin directly to the affected area with each diaper change for 7-14 days.
• Popular over-the-counter options include Lotrimin AF (clotrimazole 1%) or Monistat-Derm (miconazole 2%), while prescription-strength nystatin cream may be needed for severe cases.
• Before application, gently clean the area with warm water and pat dry completely.
• Allow the baby's bottom to air-dry for several minutes before applying a thin layer of the antifungal cream, followed by a barrier cream containing zinc oxide.
• Change diapers frequently, at least every 2-3 hours during the day and once during the night, to keep the area dry.

Identifying Yeast Diaper Rash

Yeast diaper rashes occur when Candida fungi overgrow in the warm, moist environment of a diaper. These rashes appear as bright red patches with distinct borders, sometimes with small red dots or pimples at the edges, and typically don't respond to regular diaper rash creams.

Monitoring and Follow-Up

If the rash doesn't improve within 3-5 days of treatment, worsens, or if your baby develops a fever, contact your pediatrician. It's essential to prioritize the baby's health and adjust the treatment plan as needed to prevent complications and ensure the best possible outcome.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Very moist lesions are best treated with the topical dusting powder. Adults and Pediatric Patients (Neonates and Older): Apply to candidal lesions two or three times daily until healing is complete. INDICATIONS AND USAGE Nystatin Topical Powder is indicated in the treatment of cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species.

Yeast Diaper Rash Treatment:

• The drug label for nystatin (TOP) indicates that it can be used to treat cutaneous or mucocutaneous mycotic infections caused by Candida species, which includes yeast diaper rash.
• For very moist lesions, such as those found in yeast diaper rash, the topical dusting powder is recommended.
• The treatment should be applied two or three times daily until healing is complete 2.
• Nystatin topical powder is indicated for the treatment of cutaneous or mucocutaneous mycotic infections caused by Candida albicans and other susceptible Candida species 2.

From the Research

Yeast Diaper Rash Treatment

• Yeast diaper rash, also known as diaper dermatitis, is a common condition in infants that can be complicated by Candida superinfection 3.
• Treatment options for yeast diaper rash include antifungal pastes, such as clotrimazole and nystatin, which have been shown to be effective in reducing symptom scores and promoting clinical cure 3, 4.
• A study comparing the efficacy and safety of clotrimazole and nystatin in infants with diaper dermatitis found that clotrimazole was superior to nystatin in reducing symptom scores and promoting clinical cure 3.
• Another study found that fluconazole was superior to nystatin in treating oral candidiasis in infants, with a clinical cure rate of 100% compared to 32% for nystatin 5.
• Mupirocin has also been shown to be effective in treating diaper candidosis, with a faster response time and higher clinical cure rate compared to nystatin 6.
• A review of topical and systemic treatments for cutaneous candidiasis found that clotrimazole, nystatin, and miconazole were the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%-100% 4.
• Miconazole nitrate ointment has also been shown to be effective in treating diaper dermatitis complicated by candidiasis, with a significant improvement in clinical cure rates and microbiologic cure rates compared to a vehicle control 7.

Treatment Options

• Clotrimazole: an antifungal paste that has been shown to be effective in reducing symptom scores and promoting clinical cure in infants with diaper dermatitis 3, 4.
• Nystatin: an antifungal paste that has been shown to be effective in treating diaper dermatitis, but may have a lower clinical cure rate compared to clotrimazole 3, 4.
• Fluconazole: an oral antifungal medication that has been shown to be effective in treating oral candidiasis in infants, but may not be suitable for topical use in diaper dermatitis 5.
• Mupirocin: a topical antifungal medication that has been shown to be effective in treating diaper candidosis, but may not be suitable for widespread use in diaper dermatitis 6.
• Miconazole nitrate ointment: a topical antifungal medication that has been shown to be effective in treating diaper dermatitis complicated by candidiasis 7.