11.22 Diaper Rash
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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:
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- Do not let the parents be distracted by drying 
    or emollient 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
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Superinfection with Candida is common enough to 
treat presumptively in every case of diaper rash 
severe enough to be brought to the ED.


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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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