Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Candidiasis/Diaper Rash
CANDIDIASIS/DIAPER RASH
Diaper dermatitis characterized by inflammation with a well-defined, scaling border.
I. Etiology: Candida albicans is the usual causative agent.
II. Incidence
A. Most common form of cutaneous candidiasis is in the diaper area of infants.
B. Most prevalent in infants under 6 months of age
III. Incubation period: Unknown
IV. Subjective data
A. Erythematous rash in diaper area
B. Satellite lesions: Outside border of rash
C. Baby does not appear uncomfortable.
D. History of vaginal infection in mother
E. Oral thrush may be present
F. History of antibiotic use may precede development of rash.
V. Objective data
A. Diaper area
1. Beefy, red, shiny
2. Sharply demarcated borders
3. Satellite lesions: Erythematous papules or pustules
B. Inspect entire body; candidiasis may be found in intertriginous areas (e.g., neck, axilla, umbilicus)
C. Inspect mouth for oral candidiasis (thrush)
VI. Assessment
A. Diagnosis is made by a detailed history or the clinical picture.
B. Potassium hydroxide (KOH) fungal preparation reveals yeast cells and pseudohyphae.
C. Differential diagnosis
1. Ammoniacal diaper rash
2. Chronic mucocutaneous candidiasis reflecting an underlying immunodeficiency
VII. Plan
A. Clotrimazole (Lotrimin) cream: Small amount bid or
B. Miconazole (Monistat Derm): Small amount bid
C. Nystatin (Mycostatin) cream: Liberally applied bid
D. Nystatin powder three times daily for use for concurrent candidiasis in moist intertriginous areas
E. Burow’s solution compresses 20 minutes tid
1. Use for severe inflammation or oozing.
2. Dissolve 1 packet in 1 pint of water (1:40 dilution).
VIII. Education
A. Change diapers frequently.
B. Cleanse diaper area with tepid water at each diaper change.
C. Keep baby clean and dry, with special attention to warm, moist areas.
D. Careful handwashing technique; candidiasis is transmitted by direct contact with secretions and excretions.
E. Check entire body for appearance of rash in intertriginous areas.
F. Medication
1. Use medication sparingly.
2. Be alert for drug sensitivity: Itching, irritation, maceration, secondary infection.
3. Do not use medication for other rashes.
4. Continue medication for at least 3 full days after disappearance of rash.
G. Use soft cotton cloth or face cloth for Burow’s compresses. Keep solution in covered container.
H. Keep child without diapers as often as possible; C. albicans thrives in warm, moist areas.
I. Do not use plastic pants.
J. Do not use cornstarch; it may be metabolized by microorganisms.
K. If mother is suspect for vaginal candidiasis, refer for diagnosis.
IX. Follow-up
A. Check mouth frequently; call immediately if white spots are present.
B. Call back in 3 days if no improvement.
C. Telephone call to report progress in 6 to 7 days
X. Complications: Overuse of topical corticosteroids may result in striae or telangiectasia.
XI. Consultation/referral
A. Frequent recurrences: May require oral nystatin therapy to eliminate
C. albicans in the intestine; may also reflect an underlying immunodeficiency
B. Failure to respond to treatment after 1 week