Diaper Rash

11.22 Diaper Rash

Presentation
An infant has worn a wet diaper too long, and has developed an uncomfortable rash, which may range fron simple redness to macerated and superinfected skin. Hallmarks of Candida (monilia) infection are often present, including intensely red, raw areas, satellite lesions, and white exudate.
What to do:



Instruct the parents that it is imperative that the child go "bare" and wear no diaper until the rash has healed. This may increase the laundry load, but it allows the skin to dry, avoid physical trauma, and restore its natural defenses. This is usually all that is necessary to clear up a diaper rash in 2-3 days, but . . .



To speed recovery from the frequent superinfection of Candida (present in the feces) and less-frequent superinfection with other dermatophytes, you may add topical treatment with clotrimazole (Lotrimin) or nystatin (mycostatin) cream, applied 3 or 4 times daily until the rash has been healed for 2 days.



Make sure the family has a pediatrician for further followup.
What not to do:



Do not let the parents be distracted by drying or emolient medications. Going bare is the basis of treatment.



Do not recommend talcum powder or "talcum free" powders for use when diapers are changed. They add little in terms of medication or absorbency, and are occasionally aspirated by infants as their diapers are being changed.
Discussion
Superinfection with Candida is common enough to treat presumptively in every case of diaper rash severe enough to be brought to the ED.