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. USUAL DOSAGE: Apply to affected area 2 or 3 times daily.
The dosing for Nystatin in the treatment of candidal diaper dermatitis is to apply the topical dusting powder to the affected area 2 or 3 times daily until healing is complete 1 1.
From the Research
For candida diaper rash, apply nystatin cream or ointment (100,000 units/gram) to the affected area 2-4 times daily after gentle cleansing and drying, continuing for 2-3 days after the rash resolves (typically 7-14 days total). This recommendation is based on the most recent and highest quality study available, which compared the efficacy and safety of two antifungal pastes in infants with diaper dermatitis 2. The study found that both clotrimazole and nystatin were effective in reducing symptom scores and achieving clinical cure, but clotrimazole was superior to nystatin in terms of reduction in symptom score and global assessment of clinical response. However, nystatin is still a safe and effective treatment option for candida diaper rash, especially when used in combination with good hygiene practices such as frequent diaper changes and allowing air exposure to the affected area. It's also important to note that nystatin works by binding to ergosterol in the fungal cell membrane, creating pores that lead to cell death, and has minimal systemic absorption, making it safe for infants 3. If the rash doesn't improve within a week, it's recommended to consult a healthcare provider as a different treatment may be needed. Some studies also suggest that miconazole nitrate 0.25% and mupirocin may be effective alternatives to nystatin for the treatment of candida diaper rash 3, 4. However, the use of these alternative treatments should be based on the specific clinical presentation and medical history of the infant, and should be guided by the most recent and highest quality evidence available. In general, the treatment of candida diaper rash should prioritize the use of antifungal agents that are safe and effective, and should be combined with good hygiene practices to promote healing and prevent recurrence. Key points to consider when treating candida diaper rash include:
- Using an antifungal agent that is safe and effective for infants, such as nystatin or clotrimazole
- Applying the antifungal agent 2-4 times daily after gentle cleansing and drying
- Continuing treatment for 2-3 days after the rash resolves, typically 7-14 days total
- Practicing good hygiene, including frequent diaper changes and allowing air exposure to the affected area
- Avoiding the use of occlusive barriers, such as petroleum jelly, which can trap moisture and worsen the infection.