Candida diaper dermatitis (CDD)

• CDD is common during the second to fourth months of life in healthy infants
• Candida albicans is present in the feces of 90% of such infants

Non-Pharmacological Management

• Treatment should include decreasing maceration of the skin by eliminating impervious diaper covers
• changing diapers frequently and leaving diapers off for long periods of time.

Topical Antifungal

• Topical antifungal therapy is also necessary.
• In one randomized, double-blind, controlled trial comparing miconazole ointment with zinc oxide petroleum base, miconazole was safe and more effective, particularly in moderate to severe cases.
• Ointments, creams and powders of nystatin, miconazole and clotrimazole are available
• How long treatment should last has not been completely defined, although typically the cream or ointment is applied at each diaper change until the rash is resolved, usually in four to seven days.

Oral Antifungal

• It is still not clear whether concomitant oral and topical antifungals should be recommended.
• In two studies, no difference in the initial clinical responses was found.
• In another study, relapses were decreased (although not significantly) when an oral supplement of nonabsorbable nystatin was added to the topical ointment of nystatin (16% versus 33%).

Topical Anti-inflammatory Agents

• There are no well-designed trials to assess the efficacy of adding a topical anti-inflammatory agent in treatment of CDD.
• Potent anti-inflamatory preparations, such as those with high concentrations of steroids, may impair the response to antifungal agents and should be avoided.
• The place for low concentrations of steroids (eg, 1% hydrocortisone) is unclear.
• Although some experts never use steroids with antifungal agents, others advocate them in CDD.

Others

• Some studies have indicated that preventing diaper rash may be done by applying barrier creams like zinc oxide (A & D Ointment, Desitin, Diaparene) or petroleum jelly (Vaseline, Aquaphor) to the diaper area after bathing.
• These products may help to decrease the ambient moisture in the diaper area after bathing or changing a diaper.
• Gentle cleaning to minimize skin breakdown may also be helpful.
• Air exposure (for example, no diaper) is also therapeutic.

Recommendations

• Miconazole 2% BD, continued at least one week after disappearance of signs OR
• Clotrimazole 1% BD-TDS for 2-3 weeks
• Products generally recommended for children above 2 years. Usage for below 2 years is supported by guides, but should be monitored by physicians

References: 

1. Antifungal agents for common outpatient paediatric infections. Feb 1 2016
2. http://www.emedicinehealth.com/yeast_infection_diaper_rash/page3_em.htm
3. http://emedicine.medscape.com/article/801222-treatment