Candida albicans infection and napkin rash.
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Candida albicans↗
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Alimentary Candida albicans and napkin rashes.
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Administration, Oral↗
Ammonia dermatitis: "Nappy rash".
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Acetates↗
Getting to the bottom of nappy rash. ALSPAC Survey Team. Avon Longitudinal Study of Pregnancy and Childhood.
BACKGROUND: Nappy rash accounts for 20% of dermatology consultations in childhood, but its causes are poorly understood. AIM: To determine the incidence of nappy rash during the first four weeks of life in a geographically defined United Kingdom (UK) population, and to study the factors associated with developing the rash. METHOD: The data are derived from self-completed questionnaires of parents in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). The response rate to a questionnaire about the child administered four weeks after delivery among parents of singleton infants was 87% (12103/13902). RESULTS: The incidence of nappy rash was 25%. Fourteen highly significant possible causal factors emerged, of which 10 were retained in a logistic regression model: dirtying of nappy, contact with doctor about other problems, history of rashes in joints or skin creases, type of nappy worn, being fed cereal, taken to mother's bed when waking at night, history of cradle cap, general state of health, previous stomach upset, and being only breast-fed. However, the relative risks were generally small. CONCLUSIONS: The likelihood of nappy rash increases with intercurrent illness and early introduction of cereals. Disposable nappies give little protection, and this finding helps to endorse a recently introduced hospital scheme arising from environmental concerns that encourages parents to use cotton nappies instead of disposables. For many babies, however, the causes of nappy rash remain unknown.
Analysis of Variance↗
Nappy rash: let's give mothers more help.
Nappy rash affects most babies at some stage. It can occur at any time during the nappy-wearing years, but reaches a peak between 7 and 12 months. Nappy rash causes discomfort to babies and distress to mothers, who often feel guilty and ill-prepared for this problem. Keeping the nappy area dry is the most important factor in prevention and treatment. Recommend frequent changes of nappy and leaving the area uncovered when possible. Thrush is present in many cases of nappy rash. Keeping the area dry deprives thrush of the opportunity to thrive.
Adult↗
"Timodine" cream in the treatment of flexural dermatoses and napkin rash.
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Benzalkonium Compounds↗
Nappy rash: a pharmaceutical approach.
Before dealing with nappy rash, first examine the cause. Simple precautions such as frequent changing of the nappy, cleaning the skin and applying a water-repellent barrier cream can prevent some types of nappy rash from occurring. Creams and ointments for nappy rash contain a variety of ingredients such as emollients, water-repellents, antiseptics, astringents and anti-inflammatory agents. Nappy rash caused by Candida (thrush) needs to be treated with specific antifungals, eg clotrimazole, nystatin, miconazole. Rashes which do not settle or which recur frequently should be referred to a doctor for further investigation and treatment.
Diaper Rash↗
Role of Candida albicans infection in napkin rashes.
Skin scrapings, mouth swabs, and faecal specimens from children with eruptions in the napkin area and from a series of normal infants were examined for the presence of Candida albicans.This was found in 41% of all napkin eruptions but in only one of the 68 normal infants. While C. albicans is a common secondary invader of all types of napkin eruption, primary Candida infection of the skin in the napkin area is probably uncommon.No evidence was found that generalized psoriasiform or eczematous eruptions occurring in association with napkin rashes are due to an allergic response to the fungus. C. albicans is more likely to be present in a napkin rash if the organism has been found in the alimentary tract.
Candida↗
Symptomatic zinc deficiency in breast-fed premature infants.
We report two breast-fed premature infants who developed transient symptomatic zinc deficiency with scaly erythema of cheeks and napkin area, 9-13 weeks after birth. Serum zinc concentrations were 3.6 and 4.8 mumols/l, and the lesions healed rapidly in response to oral zinc supplements. Both mothers had low breast-milk zinc levels (2.3 and 3.2 mumols/l at 21 and 15 weeks respectively). The infants were both initially misdiagnosed as having eczema and infection. Premature infants are in negative zinc balance and though the additional factor of a low maternal breast milk zinc concentration may be necessary to provoke symptoms, rashes developing in such infants in the months following premature birth should raise the suspicion of zinc deficiency.
Breast Feeding↗
The perineal eruption of Kawasaki syndrome.
The occurrence of a distinctive perineal eruption that appears in infants and children early in the course of Kawasaki syndrome has received little attention in the medical literature. Medical records of patients hospitalized during the acute phase of Kawasaki syndrome were reviewed to evaluate the prevalence of an erythematous, desquamating perineal eruption. The frequency of this eruption was compared with the syndrome's other diagnostic criteria. Thirty-nine (67%) of the 58 patients who fulfilled the criteria for the diagnosis of Kawasaki syndrome had documentation of the perineal rash that usually occurred in the first week of onset of symptoms. No statistically significant differences were found in the frequency of coronary artery aneurysms. We believe that an erythematous, desquamating perineal rash is a valuable early clinical finding facilitating a more rapid diagnosis and treatment of Kawasaki syndrome.
Child↗
Oral candidal flora in healthy infants.
Asymptomatic oral candidal carriage has been extensively studied in adults, but only rarely in infants. The present investigation aimed to determine the asymptomatic oral carriage of candidal species in healthy infants and its relationship to age, sex, feeding pattern and use of a pacifier. The swab technique was used for oral candidal isolation. Candidal species were isolated from 48% of the infants without a significant relationship to age, gender or between breast-fed or bottle-fed infants. Similarly, a history of maternal vaginal candidosis, or presence of nappy rash, had no significant relationship to oral candidal carriage. Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.
Age Factors↗
Skin problems in children.
Common skin problems in 340 children routinely seen during a winter period, included napkin rashes in infants, atopic eczema throughout childrhood, and acne vulgaris in late childhood. Skin infections and psoriasis were also commonly seen. If possible, when topical steroid preparations more potent than hydrocortisone cream BPC are used in children, they should be used sparingly and for short periods only.
Acne Vulgaris↗
[Ketotifen poisoning in infancy?].
A male baby aged 3 1/2 months died about 3 hours after application of ketotifen due to chyme aspiration. Apart from a mycotic napkin rash the post-mortem examination did not show any other pre-existing pathological findings. When analysing blood samples toxicologically we observed a remarkably high concentration of ketotifen whereas the urine level was comparatively low. The morphological and toxicological findings are presented and discussed in differential diagnosis with reference to sudden infant death syndrome.
Diagnosis, Differential↗
[W-shaped napkin rash in infants (author's transl)].
The W-shaped napkin rash affects mainly the convex parts of the perianal region of infants, avoiding the fold and perianal cleft. The dermatitis is of traumatic origin due to the friction of paper napkins. It heals under antiseptic treatment on condition that the use of paper napkins and rubber pants, which cause occlusion is stopped temporarily.
Anti-Infective Agents, Local↗
An investigation of professional advice advocating therapeutic sun exposure.
OBJECTIVE: To determine the prevalence of inappropriate professional advice advocating therapeutic sun exposure in infancy and the post-partum period. METHODS: Self-administered postal questionnaires were completed by doctors (n=130; 71% response) and nurses (n=285; 58.6% response) responsible for the care of post-parturient women in eight hospitals in metropolitan and regional Queensland (1999/2000). RESULTS: Both groups reported several risky beliefs about the therapeutic benefits of sun exposure including using sunlight to treat: cracked nipples (41.1% nurses, 46.2% doctors); neonatal jaundice (49.5%, 34.9%); nappy rash (23.3%, 19.5%); and acne (12.3%, 20.2%). Approximately 10% of nurses and doctors recommended sunlight to treat sore/cracked nipples from breastfeeding, while 42% recommended sun exposure to treat neonatal jaundice. Relatively few doctors and nurses who recommended therapeutic sun exposure stipulated sunning through a window. Subtropical residence was a significant predictor of recommending sunlight to treat cracked nipples (p=0.002) and nappy rash (p=0.0005) among nursing staff. Midwives were more likely to recommend sunlight for neonatal jaundice than other nurses (p=0.004). Obstetricians (p=0.046), older doctors (p=0.049) and those who qualified earlier (p=0.031) were more likely to recommend sunlight to treat nappy rash. Paediatricians and neonatologists were less likely to recommend sunlight to treat neonatal jaundice than obstetricians and other doctors (p=0.009). CONCLUSIONS AND IMPLICATIONS: An education program is needed to change the practices of health professionals who recommend therapeutic sun exposure and should coincide with a health promotion campaign aimed at reducing the prevalence of related risky beliefs among parents.
Adult↗
Anogenital and buttock ulceration in infancy.
Rashes in the anogenital and buttock region are some of the commonest dermatological problems occurring in infancy. The most frequent causes seen in clinical practice are ulcerating haemangiomas, bullous impetigo and severe irritant contact dermatitis. Other causes include nutritional deficiencies, bullous diseases, trauma, Langerhans cell histiocytoses and inflammatory disorders such as pyoderma gangrenosum and Crohn's disease. This review presents a brief overview of these causes and outlines the recommended management strategies.
Buttocks↗
What can be done to keep babies' skin healthy?
Establishing a skincare routine that keeps babies' skin healthy remains a challenge for midwives and parents, since up to 50% of babies suffer from at least one episode of nappy rash at some time. Nappy rash is an irritant contact dermatitis caused by the interaction of several factors, particularly the prolonged contact of the skin with urine and faeces, which makes the skin more prone to disruption through friction with the nappy. Infection is not a primary cause of nappy rash, though secondary infection by Candida albicans can occur. Prevention of nappy rash is the ultimate goal, but if the condition does develop, treatment should aim to reverse the skin damage and prevent recurrence. We propose that routine baby skincare should comprise gentle cleansing whenever the nappy is soiled (using warm water or alcohol-free baby wipes), the use of good-quality super-absorbent nappies, and the application of a barrier preparation at every nappy change. Ideally, a barrier preparation should be clinically proven to be effective in babies and mimic the skin's natural function by forming a long-lasting barrier to maintain optimum moisture levels. It should not contain any unnecessary ingredients, including antiseptic, preservative or perfume (or other potential sensitisers), or any ingredients that are toxic or have undocumented safety. Treatment of nappy rash should comprise essentially the same actions as its prevention. Application of a barrier ointment at every nappy change can help to both prevent and treat this condition. Topical steroid therapy should be reserved for use where the condition has failed to respond to other approaches, and antifungal treatment should only be employed where Candida infection is established or suspected. Implementing these measures would form a simple skincare routine that could help keep babies' skin healthy.
Candidiasis, Cutaneous↗
Why do mothers still sun their infants?
OBJECTIVE: To determine the prevalence of maternal beliefs about the therapeutic uses of sunlight in infancy in tropical Australia. METHODOLOGY: Data were collected by interviewing 114 post-partum patients in Townsville (19 degrees 16'S), Queensland. Each woman was asked a series of open-ended and set-response questions about ancestry, pigmentation, residential history, parity, maternal and paternal education, and beliefs regarding the reputed therapeutic uses of sunlight. RESULTS: Half of the women had at least one risky belief about the perceived benefits of sunning their baby. Thirty-six per cent were in favour of using sunlight to treat neonatal jaundice; 20.2% believed it was necessary to intentionally sun their baby to prevent vitamin D deficiency; and 10.5% thought sunlight was a good remedy for nappy rash. Independent predictors of one or more of these beliefs included maternal age and education level, and having another child that had been treated for jaundice. Forty per cent of multiparous women had sunned a child to treat neonatal jaundice. In most cases, advice to mothers to sun their baby had been given by a midwife/nurse (41% or a doctor/paediatrician (28%). CONCLUSIONS: Post-parturient women had a high prevalence of beliefs that may result in their infant being intentionally exposed to sunlight, and which could increase their child's future risk of skin neoplasia. Midwives and doctors, including paediatricians, were identified as the major professional sources of these beliefs. Professional education is needed to change the beliefs of health professionals who recommend therapies involving sunlight.
Adolescent↗