Yellow Prescription Cream for Diaper Rash
The yellow cream the mother is describing is most likely nystatin topical powder or ointment, a commonly prescribed antifungal medication for Candida-associated diaper dermatitis.
Identification of the Yellow Cream
Nystatin preparations characteristically have a yellow appearance and are FDA-approved for treating cutaneous mycotic infections caused by Candida albicans and other susceptible Candida species 1. This medication is specifically indicated for cutaneous or mucocutaneous candidal infections, making it ideal for diaper rash complicated by fungal overgrowth 1.
Why Nystatin Works for Diaper Rash
Candida is isolated in more than 80% of secondary infections in diaper dermatitis 2. The diaper area creates ideal conditions for fungal growth due to:
- Increased moisture and friction 2
- Elevated pH from urine 2
- Irritating enzymes (lipases and proteases) from feces 2
Nystatin acts by binding to sterols in the fungal cell membrane, causing membrane permeability changes and leakage of intracellular components 1. It is both fungistatic and fungicidal against a wide variety of yeasts and yeast-like fungi 1.
Treatment Recommendations
For diaper dermatitis with suspected Candida involvement, topical antifungal therapy is the standard approach:
- Nystatin remains an effective first-line option, though topically applied azole drugs are generally more effective 3
- Clotrimazole 1% cream applied to the affected area 2-3 times daily is superior to nystatin in clinical trials, with higher cure rates (68.1% vs 46.9% at 14 days) and better symptom reduction 4
- Miconazole 2% cream is another effective alternative available over-the-counter 3
Prescribing Guidance
If you choose to prescribe nystatin (the yellow cream she remembers):
- Apply topically 3-4 times daily or with each diaper change 5
- Continue treatment for 7-14 days even if symptoms improve earlier 3
- Nystatin exhibits no appreciable activity against bacteria, so if there is secondary bacterial infection, additional therapy may be needed 1
However, consider prescribing clotrimazole instead, as it demonstrates superior efficacy in head-to-head trials 4 and is recommended by multiple guidelines as more effective than nystatin 3.
Important Caveats
- Confirm the diagnosis with clinical examination looking for satellite lesions, beefy-red erythema, and involvement of skin folds characteristic of candidal infection 2
- If the rash does not improve within 2-3 days or worsens, consider KOH preparation or culture to confirm Candida and rule out resistant strains or alternative diagnoses 1, 2
- Resistant Candida strains to nystatin are uncommon but can occur, particularly with non-albicans species 1, 2
- Keep the diaper area dry and change diapers frequently as adjunctive measures 3