From the Guidelines
Cutaneous candidiasis in infants is typically treated with topical antifungal medications, as recommended by the Infectious Diseases Society of America in their 2016 clinical practice guideline update 1. The first-line treatment is nystatin cream or ointment applied to affected areas 2-4 times daily for 7-14 days. Alternatively, clotrimazole 1% or miconazole 2% cream can be used with the same frequency and duration. For diaper rash with candidiasis (diaper dermatitis), it is essential to:
- Keep the area clean and dry
- Change diapers frequently
- Apply the antifungal cream at each diaper change A thin layer is sufficient; avoid excessive application. For severe or persistent cases, a combination product containing a mild corticosteroid (like hydrocortisone 1%) and an antifungal may be prescribed for short-term use (3-5 days). Oral antifungals are rarely needed for cutaneous candidiasis in infants, as stated in the practice guidelines for the treatment of candidiasis by the Infectious Diseases Society of America 1. These treatments work by disrupting the fungal cell membrane, preventing growth and reproduction of the Candida yeast. Most cases resolve within 1-2 weeks with proper treatment and hygiene measures. If the infection doesn't improve within a week, spreads, or if the infant develops fever, consult a healthcare provider promptly as this may indicate a more serious infection requiring different management.
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.
The treatment for cutaneous candidiasis in infants is applying nystatin topical powder to the affected area two or three times daily until healing is complete 2. This is based on the indication that nystatin topical powder is used to treat cutaneous mycotic infections caused by Candida species 2.
- Key points:
- Apply topical dusting powder to very moist lesions
- Apply two or three times daily
- Continue until healing is complete
From the Research
Treatment for Cutaneous Candidiasis in Infants
- The treatment for cutaneous candidiasis in infants typically involves the use of antifungal agents, which can be administered topically or systemically 3, 4.
- Topical antifungal agents such as clotrimazole, nystatin, and miconazole have been shown to be effective in treating cutaneous candidiasis in infants, with complete cure rates of 73%-100% 4.
- Systemic antifungal therapy, such as oral fluconazole, may be necessary in severe cases or when topical treatment is not effective 4.
- Prompt systemic antifungal treatment at the time of skin presentation for ≥14 days has been shown to prevent dissemination and Candida-related mortality in infants with congenital cutaneous candidiasis 3.
- It is essential to eradicate or amend predisposing factors, such as diaper dermatitis, to prevent the recurrence of cutaneous candidiasis in infants 5.
Topical Antifungal Agents
- Clotrimazole, nystatin, and miconazole are the most studied topical antifungal agents for cutaneous candidiasis, with similar efficacy and mild adverse effects 4.
- Topical allylamines, such as naftifine, have also been shown to be effective in treating cutaneous dermatophytosis and may be used as an alternative to azoles 6.
- Clotrimazole has been shown to be effective in treating vaginal and skin infections caused by yeasts and dermatophytes, with cure rates comparable to those of nystatin 7.