Yeast Diaper Rash: Causes, Symptoms, And Treatment

Diapers and tiny baby bottoms are part of a parent’s daily life. Unfortunately, diaper rash can be quite common, too. However, there’s a difference between a regular diaper rash and a yeast infection diaper rash. If you think your baby might have the latter, this article is for you.

We’ll discuss what causes a yeast diaper rash as well as what symptoms to look for. We’ll also share tips for treating this specific type of rash.

But before we dive in, let’s talk about exactly what this yeast diaper rash is and how it differs from other diaper rashes.

Table Of Contents

• What Is A Yeast Diaper Rash?
• Causes Of Yeast Diaper Rash
• Yeast Diaper Rash Symptoms
• How Long Will Treatment Take?
• Do Yeast Diaper Rashes Hurt?
• Possible Complications
• Other Potential Culprits Of Your Baby’s Rash
• Treating Your Baby’s Yeast Diaper Rash
• Post-Rash Care
• Preventing Yeast Diaper Rashes From Returning

What Is A Yeast Diaper Rash?

Diaper rash is not all that unusual. In fact, run-of-the-mill diaper rash (dermatitis) is caused simply by irritation. However, this average diaper rash is different from a yeast diaper rash.

Yeast (Candida) is a type of fungus that occurs naturally in the human body. But when growth is out of control, it creates what we call a “yeast infection.”

That yeast overgrowth is exactly what causes a yeast infection diaper rash (or just “yeast diaper rash”). It is, simply put, a fungal infection.

Because yeast thrives in warm, moist environments, it’s no surprise that a yeast diaper rash can quickly crop up. Let’s take a look at what causes a yeast diaper rash and what factors leave your baby’s skin susceptible.

Causes Of Yeast Diaper Rash

The cause of a yeast diaper rash is simple and what we just mentioned in the section above: an overgrowth of yeast. Here are some factors that can contribute or lead to a yeast overgrowth.

A Moist Environment

As we mentioned, yeast loves warm, moist environments, and your baby’s diaper area is just that — especially in the folds of their skin.

A Regular Diaper Rash

Unfortunately, if your little one has a regular diaper rash, it means their skin is already irritated, compromised, and susceptible to a yeast diaper rash. That’s because their natural skin barrier is weakened and isn’t as well-equipped to keep the yeast at bay.

Antibiotics

Antibiotics are a marvel of modern medicine.

But, while they can do away with bacteria that may be making you or your baby sick, antibiotics can also alter the good bacteria in the body. Sometimes, a change in good bacteria gives yeast the chance to grow.

This means that babies who are on antibiotics may be more likely to develop a yeast diaper rash. The same is true for breastfeeding babies if their mom is taking antibiotics.

Thrush

Thrush is in the mouth and may seem like it has nothing to do with a diaper rash, but it does!

Since thrush is also a yeast infection, the yeast can go in one end and out the other (if you know what we mean). That means it can end up in your baby’s diaper and on their bum.

So, if your baby recently or currently has thrush, it won’t be surprising if they also develop a yeast diaper rash.

Frequent Bowel Movements

If your baby’s got to go, they’ve got to go. But frequent bowel movements mean more chances for a yeast diaper rash.

That’s because the stool itself can affect the balance of bacteria on the skin. It can also cause irritation, which, as we know, makes it easier for yeast to take over.

Babies who recently had a bout of diarrhea are particularly prone to a yeast diaper rash.

Now that you know what causes and contributes to a yeast diaper rash’s development, let’s look at what you should be watching out for. Identifying the signs and symptoms will help you determine if your baby has this type of rash or something else entirely.

Yeast Infection Diaper Rash Symptoms

What does a yeast diaper rash look like? Ingrid Polcari MD, FAAP writes this for the American Academy of Pediatrics:

“Clues that the rash might be due to a yeast infection include shiny, bright red or pink patches with sharp edges. This rash may also have little pink bumps or pimples. In severe cases, there may be sores or cracking skin that oozes or bleeds. Unlike with irritant diaper rash, a yeast diaper rash is usually worse in the groin folds.”

In addition, a yeast diaper rash is typically well-defined and may be slightly raised on the edges. It can also have “satellite” rashes near the main rash.

And, of course, one of the clues will be that it doesn’t go away when you treat it as you would a regular diaper rash.

To help you determine which type of rash you’re dealing with, here’s a quick look at the main differences between the two.

Yeast Diaper Rash Vs. Regular Diaper Rash

 
Baby with normal diaper rash

Color

Yeast diaper rashes are usually bright red or pink. On the other hand, normal diaper rashes often have a more flushed appearance and can be darker in color.

Location

If the redness is worse in the folds of skin near the groin, it’s likely a yeast diaper rash. An everyday, irritant-caused rash is most often found on the chubby parts of the bum.

In addition, yeast rashes may have several smaller spots throughout the diaper area. A plain rash is usually found in one larger area without the “satellite” patches.

Texture

Bumpy, cracked, or oozy skin indicates yeast is causing the rash. In addition, the red patches may have a shiny appearance. Conversely, regular rashes are usually smoother and look dry.

Treatment

Yeast diaper rashes won’t respond to a regular diaper rash cream. If the rash lasts longer than three days and isn’t getting better with your home treatments, it’s likely caused by yeast.

How Long Will Treatment Take?

The length of time it takes to treat a yeast diaper rash will depend on the severity of your little one’s rash and how quickly you start treating it.

Once you begin using an antifungal cream, a yeast diaper rash usually takes anywhere from a few days to three weeks to fully clear up. Keep in mind the redness may go away during the healing process before the yeast overgrowth is taken care of.

So don’t stop using the medication as soon as the rash is gone. Keep applying the cream as directed until the entire course of treatment is complete. This way, you minimize the chances of the condition coming back.

If your baby’s bum isn’t improving after a few days, it’s best to check back in with their doctor for a reevaluation.

Do Yeast Diaper Rashes Hurt?

Yeast diaper rashes look awful, but they are often more itchy and uncomfortable than painful.

However, you may notice your baby trying to scratch their bum or rub it against something. They may also be extra fussy or irritable during diaper changes. This is normal, and it happens because you’re moving and wiping an area that’s not feeling so great.

If your baby seems to be in genuine pain, contact their doctor as soon as possible. They can recommend additional ways to help your child feel better.

Possible Complications

Left untreated, the rash might ooze, become more painful, and spread. It can also become infected, especially if your baby scratches the rash and causes more open sores.

Keep your eyes peeled for any signs of infection, like a red streak around the rash or a fever. These symptoms could indicate something more serious is going on that’ll require different treatment.

Other Potential Culprits Of Your Baby’s Rash

Diaper rashes aren’t the only skin condition that can cause angry red patches to appear on your child’s bottom. Here are two other potential causes:

Bacterial Infection

Impetigo or another bacteria-related infection can cause red, itchy bumps on your baby’s bum. If your child has any raised, fluid-filled areas or crusted-over lesions, take them to the doctor right away.

Psoriasis

People with psoriasis can develop red, scaly patches of skin anywhere on their body, including in the diaper region. Studies show that up to 30% of patients notice psoriasis in this part of their body first.

If you see any of the classic signs of psoriasis, such as dry, patchy skin or silver-colored scales, on your baby’s bottom near the diaper line, schedule an appointment with their doctor for a definitive diagnosis. They may need steroids or hydrocortisone cream to help clear up their skin.

Now that you know more about this type of rash, that brings us to the final (but arguably most important) part of this article: how to treat your baby’s yeast diaper rash.

Treating Your Baby’s Yeast Diaper Rash

First of all, if your baby has a diaper rash that just won’t go away, it’s a good idea to speak with their pediatrician — especially if the rash starts looking questionable or your little one has a fever.

If your baby does have a yeast diaper rash, the doctor will be able to confirm that and recommend treatment.

As soothing as regular diaper cream is, it doesn’t get rid of yeast. You’ll need an antifungal cream, and your pediatrician can advise you about this and prescribe a cream if necessary.

In addition to the cream, it’s essential to help your baby’s skin along as it heals. Below, we’ll list several ways to care for your baby’s bum that can help kick a yeast diaper rash.

But keep in mind that these are also good habits to get into to help prevent diaper rash in the first place!

Change Your Baby Frequently

Because yeast grows in moist environments, you’ll want to change your baby’s diaper frequently so they are in a dry diaper as much as possible. Get in the habit of checking their diaper regularly and changing it as soon as possible when it’s wet or soiled.

Clean Skin Thoroughly (But Gently!)

When you change your baby’s diaper, it’s important to clean their skin thoroughly but ever-so-gently. Use an extra-soft washcloth with warm water or damp cotton balls to clean the area.

If you prefer to use baby wipes, opt for natural, fragrance-free wipes that are designed for extra-sensitive skin.

Mustela Certified Organic Water Wipes are ultra-soft, fragrance-free, and created to effectively and carefully clean very sensitive, rashy, or reactive skin.

Plus, they’re made of 99% plant-based ingredients and EWG Verified, so you can feel good about what you put on your little one’s delicate skin.

Air Dry

Instead of rubbing your baby’s bum dry and adding to the irritation, opt for air drying. When using this method, just be sure that their skin is dry before diapering them again.

If you’re in a rush, try a hairdryer on the cool setting. But always test the air on your skin first, as it can be too hot for your baby’s delicate bottom.

Skip The Diaper

Whether it’s after a diaper change to help dry their skin or in the middle of the day when you’re at home, it’s always a good idea to skip the diaper and let your baby hang out in their birthday suit for a while.

Just remember to put your little one somewhere that’s easy to clean up in case nature calls! A plush towel works well for absorbing any accidents. It also gives your little one a soft place to rest while they enjoy some fresh air on their bottom.

Loosen The Diaper

When you fasten your baby’s diaper too tightly, the rubbing can irritate their skin, but that’s only one of the problems. A tight diaper also keeps moisture in, which is exactly what you don’t want when dealing with yeast.

To prevent this, ensure you’re not fastening their diaper too tightly. It should be snug enough to stay in place but not so tight that it’s leaving marks or red spots on their skin.

Go Up A Diaper Size

Speaking of tight diapers, if the one your baby is wearing seems to be a bit snug, try going up a size. It’s always best for your little one to have a diaper that fits properly, but it’s even more important when they have any kind of diaper rash.

You should be able to run two fingers under the diaper’s waistband once it’s on. If you can’t, it’s time to go up a size.

Properly Clean Cloth Diapers

If you use cloth diapers instead of disposables, the material can hang onto yeast for a long time. Your regular washing routine may not be enough to get rid of it. Unfortunately, this means you’ll be reinfecting your little one each time you put a diaper on them.

To kill the yeast from your diapers, you’ll want to let them soak for 30 minutes in a cold, diluted bleach water solution. Then, rinse them in hot water before you wash them.

You should then hang your diapers out to dry so the UV rays from the sun can further eliminate any yeast buildup.

Because the risk of reinfection is high, many parents choose to put their baby in disposables for the duration of their yeast diaper rash. This way, they don’t worry about infecting their entire stash of cloth diapers.

Wash Your Hands

This is a good rule of thumb for any diaper change, but, when dealing with a yeast diaper rash, be sure to clean your hands before and after changing your baby’s diaper. Use soap and hot water to wash, and scrub your hands for at least 20 seconds.

This helps prevent the continuous spread of yeast to you and your baby. Since this condition is contagious, you can get a yeast infection if you don’t use proper hygiene.

Use Gentle Skincare Products

A baby’s skin is often sensitive to lotions, creams, shampoos, and other skincare products. But if your baby has problematic skin or is dealing with a rash, you’ll want to be extra careful with the products you use on them.

Bathe your baby with a soap designed especially for delicate skin, like our Soothing Cleansing Gel. This EWG Verified product effectively cleans your baby’s hair and body while soothing their skin. And it’s designed with sensitive, rashy skin in mind.

Post-Rash Care

Once your baby’s rash is gone, you can ditch the antifungal cream. However, the rest of these tips are still good practices to stick with to help keep your baby’s skin clean and healthy.

Plus, it’s important to get in the habit of using a soothing, protecting diaper cream every day. We recommend either our Diaper Rash Cream 1 2 3 or Diaper Cream with Olive Oil and Aloe.

Diaper Cream with Olive Oil and Aloe is a talc-free formula that calms your baby’s bottom and leaves a moisturizing layer on their skin to soothe and diminish redness at every diaper change. With organic olive oil and aloe vera, it’s safe for even the most sensitive skin.

Preventing Yeast Diaper Rashes From Returning

Yeast can be hard to get rid of. And if you don’t completely eliminate it, the rash may come back.

To make sure your baby’s bum stays yeast-free, keep these tips in mind:

• Treat any yeast infections you may have. Otherwise, you risk passing it back to your baby.
• If your baby is eating solid foods, yogurt is an excellent source of probiotics that can help keep yeast levels in check.
• Talk to your baby’s doctor about probiotic supplementation.
• Rub a bit of coconut oil on your baby’s bum. The antifungal properties can help kill yeast overgrowth.
• Minimize sugar intake for your baby and yourself if you’re breastfeeding. Yeast feeds on sugar.
• If your baby has to take antibiotics, increase their diaper-free time to get more air circulating down there.
• Clean your baby well during each diaper change. Make sure you get all of the stool off their delicate skin.
• Switch to gentle skincare products from Mustela to keep your baby’s skin soft and supple.

While you may not be able to completely prevent yeast diaper rashes from coming back, these steps make it less likely for a reoccurrence to happen.

Careful Care For Baby’s Bum

While diaper rash is common, it’s still uncomfortable for your little one! And if it’s a yeast diaper rash, you’ll need to treat it a little differently.

In addition to speaking with your doctor and following their advice about antifungal cream, care for your baby’s bum and rash with the tips we mentioned in this article.

When you change your baby (which should be frequently), clean their skin with Soothing Cleansing Wipes, let their bottom air dry, and put their diaper on a little bit more loosely.

Finally, when your baby’s yeast rash is all gone, do what you can to prevent future diaper rash with a cream like our Diaper Rash Cream 1 2 3 or Diaper Cream with Olive Oil and Aloe.

While you certainly can’t guarantee that your baby will never get a diaper rash, with careful care for your baby’s bum, you can reduce the chances and keep your little one happy and comfortable!

Diaper rash Information | Mount Sinai

Dermatitis – diaper and Candida; Candida-associated diaper dermatitis; Diaper dermatitis; Dermatitis – irritant contact

A diaper rash is a skin problem that develops in the area under an infant’s diaper.

This microscopic film shows a fluorescent stain of Candida. Candida is a yeast (fungus) that causes mild disease, but in immunocompromised individuals it may cause life-threatening illness. (Image courtesy of the Centers for Disease Control and Prevention.)

Candida, a yeast organism, may cause a skin infection beneath an infant’s diaper which appears as bright red patches.

Diaper rash may be caused by chemical irritants rather than bacterial or candidal infection. Common irritants include ammonia from the breakdown of urine, acids in the stool, and soaps used in laundering cloth diapers.

Causes

Diaper rashes are common in babies between 4 to 15 months old. They may be noticed more when babies begin to eat solid foods.

Diaper rashes caused by infection with a yeast (fungus) called candida are very common in children. Candida grows best in warm, moist places, such as under a diaper. Candida diaper rash is more likely to occur in babies who:

• Are not kept clean and dry
• Are taking antibiotics or whose mothers are taking antibiotics while breastfeeding
• Have more frequent stools

Other causes of diaper rash include:

• Acids in the stool (seen more often when the child has diarrhea)
• Ammonia (a chemical produced when bacteria break down urine)
• Diapers that are too tight or rub the skin
• Reactions to soaps and other products used to clean cloth diapers

Symptoms

You may notice the following in your child’s diaper area:

• Bright red rash that gets bigger
• Very red and scaly areas on the scrotum and penis in boys
• Red or scaly areas on the labia and vagina in girls
• Pimples, blisters, ulcers, large bumps, or sores filled with pus
• Smaller red patches (called satellite lesions) that grow and blend in with the other patches

Older infants may scratch when the diaper is removed.

Diaper rashes usually do not spread beyond the edge of the diaper.

Exams and Tests

The health care provider can often diagnose a yeast diaper rash by looking at your baby’s skin. A KOH test can confirm if it is candida.

Treatment

The best treatment for a diaper rash is to keep the skin clean and dry. This also helps prevent new diaper rashes. Lay your baby on a towel without a diaper whenever possible. The more time the baby can be kept out of a diaper, the better.

Other tips include:

• Always wash your hands before and after changing a diaper.
• Change your baby’s diaper often and as soon as possible after the baby urinates or passes stool.
• Use water and a soft cloth or cotton ball to gently clean the diaper area with every diaper change. Do not rub or scrub the area. A squirt bottle of water may be used for sensitive areas.
• Pat the area dry or allow to air-dry.
• Put diapers on loosely. Diapers that are too tight do not allow enough air flow and may rub and irritate the baby’s waist or thighs.
• Using absorbent diapers helps keep the skin dry and reduces the chance of getting an infection.
• Ask your provider or nurse which creams, ointments, or powders are best to use in the diaper area.
• Ask if a diaper rash cream would be helpful. Zinc oxide or petroleum jelly-based products help keep moisture away from baby’s skin when applied to completely clean, dry skin.
• Do not use wipes that have alcohol or perfume. They may dry out or irritate the skin more.
• Do not use talc (talcum powder). It can get into your baby’s lungs.

Certain skin creams and ointments will clear up infections caused by yeast. Nystatin, miconazole, clotrimazole, and ketoconazole are commonly used medicines for yeast diaper rashes. For severe rashes, a steroid ointment, such as 1% hydrocortisone, may be applied. You can buy these without a prescription. But first ask your provider if these medicines will help.

If you use cloth diapers:

• Do not put plastic or rubber pants over the diaper. They do not allow enough air to pass through. Use breathable diaper covers instead.
• Do not use fabric softeners or dryer sheets. They may make the rash worse.
• When washing cloth diapers, rinse 2 or 3 times to remove all soap if your child already has a rash or has had one before.

Outlook (Prognosis)

The rash usually responds well to treatment.

When to Contact a Medical Professional

Contact your child’s provider if:

• The rash gets worse or does not go away in 2 to 3 days
• The rash spreads to the abdomen, back, arms, or face
• You notice pimples, blisters, ulcers, large bumps, or sores filled with pus
• Your baby also has a fever
• Your baby develops a rash during the first 6 weeks after birth

Bender NR, Chiu YE. Eczematous disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 674.

Moon M, Guerrero AM, Li X, Koch E, Gehris RP. Dermatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 8.

Last reviewed on: 8/10/2021

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Candida vulvovaginitis in the practice of a pediatric gynecologist | Uvarova E.V.

Candida is one of the most common lesions of the lower genital tract in girls. According to the luminaries of domestic pediatric gynecology, fungi of the genus Candida are found in more than half of the cases with chronic recurrent vulvovaginitis in girls of preschool age and in 24-25% of adolescents with inflammatory diseases of the genital organs (M. N. Kuznetsova, 1998; Yu.A. Gurkin, 2000).

Risk factors for candidiasis

Analysis of morbidity by age showed that the maximum proportion of candidal vulvovaginitis occurs in the neonatal period, at the age of 3, 7 years and adolescence . The first rise is explained by the possibility of vertical intrauterine transmission of the infection from the mother, the frequent use of antibiotics in the treatment of newborns without covering with antimycotic drugs, an increased risk of infection with nosocomial strains Candida. The second rise is due to a decrease in parents’ attention to the toilet of the external genitalia in children, as well as the most pronounced allergization of children 2–3 years old. The third rise is associated with insufficient hygienic skills of girls, an increase in the number of colds and enterobiasis at the age of 7 years [Shushunova, V.G. Balasanyan, 2001]. However, it should be noted that, compared with other age periods, candidal vulvovaginitis in girls before menarche is extremely rare. In the pubertal period of life, a slight increase in the frequency of genital candidiasis, as a rule, is due to the inadequacy of hormonal ratios throughout the menstrual cycle. Deficiency of estrogenic saturation of the vaginal epithelium leads to insufficient development of lactobacilli, which are the main competitor of fungi in the vaginal biotope. A sharp increase in the incidence is observed in women who begin sexual relations.

An increased risk of Candida infections in children may be associated with a decrease in body resistance against the background of hypovitaminosis, an imbalance in the vaginal microflora, and immunodeficiency. In a number of diseases accompanied by immunosuppression of varying severity in children, a special place is occupied by acute and recurrent diseases of the oropharynx, systemic infectious diseases, endocrine pathology (hypogonadism, hypothyroidism, diabetes mellitus, adrenal hypofunction), impaired local and general circulation, neutropenia and agranulocytosis, dysbacteriosis intestines, hypovitaminosis and deficiency of trace elements, zinc, iron and magnesium. Candida vulvovaginitis in children is often a manifestation of colonization by fungi of the genus Candida of the oral cavity, intestines and surrounding skin, which, in turn, are due to the peculiarities of the diet, hygienic living conditions, the stay of girls in hospitals, infected with hospital strains of yeast fungi, etc. The occurrence of genital candidiasis is often promoted by prolonged and often uncontrolled use of antibiotics , corticosteroid drugs and cytostatics. As is known, taking most antibiotics without covering with antimycotic drugs leads to a decrease in the colonization resistance of the vagina and thereby facilitates the adhesion of fungi to the surface epithelium and their subsequent reproduction. In addition, antibiotics, corticosteroids and cytostatics cause a decrease in the content of secretory immunoglobulin, which provides local and general resistance of the child’s body to infection. Not only oral antibiotics predispose to candidiasis, but also local preparations containing iodine, as well as clindamycin, metronidazole.

The importance of sexual transmission of fungi is small, although infection from a partner with an acute stage of genital candidiasis is not denied.

A proven risk factor for the development of vaginal candidiasis is the physiological change in hormonal levels in women of young and childbearing age during pregnancy and while taking combined oral contraceptives, especially the first generation with a high content of estrogens. The absence of cyclical secretion of sex steroids, both during pregnancy and while taking combined oral contraceptives, leads to the fact that progesterone inhibits the process of blast transformation of lymphocytes to antigens Candida , and estrogens suppress the function of neutrophils. Along with this, fungal cells that have sex hormone receptors respond to changes in the hormonal environment by increasing their adhesive ability.

There is evidence of the development of vaginal candidiasis in sexually active adolescents using modern barrier methods of contraception (spermicides and condoms containing nonoxynol-9) and practicing oral sex (Nyirjesy P. et al., 1995).

Exciter

Fungi of the genus Candida belong to opportunistic aerobic microorganisms, devoid of the sexual stage of the life cycle and growing mainly in the yeast phase, i.e. multiplying budding. Thanks to this property, Candida species got their name – yeast fungi. The use of the term “yeast-like” from a modern point of view does not correspond to the true biology of the development of fungi of the genus Candida . Fungal cells, surrounded by a well-defined multi-layered membrane, can be round, ellipsoidal, oval or cylindrical in the yeast stage of development and hyphae-like in the mycelial or tissue stage of development Candida . Yeast fungi do not form true mycelium, but due to the contact of elongated cells, pseudomycelium and mitospores (asexual spores) of the fungal community are formed.

In a slightly acidic environment of the vagina at normal human body temperature, fungi of the genus Candida receive the most favorable conditions for growth and reproduction. In the mycelial phase Candida attach to the vaginal epithelium. Pseudomycelium has the ability to penetrate deep into up to 4-6 layers of the epithelium, which allows fungi to resist the natural factors of protection of the macroorganism and survive against the background of non-specific sanitation of the vagina. An increase in body temperature to 40–42°C helps to slow down the growth, but not the death of fungal cells. Growth arrest is possible when the fungus culture is heated to 50°C, and complete cell destruction occurs only during boiling.

Among the 150 known species Candida , only 20 strains are true pathogens of vaginal candidiasis, and the leaders among pathogens are only 4 species – Candida albicans , Candida tropicalis , Candida parapsil osis and Candida glabrata .

Fungi of the genus Candida are commensals of many warm-blooded animals, as they are part of the permanent microflora of the digestive tract, especially the large intestine. Candida albicans , Candida tropicalis and Candida parapsilosis can be found on the skin of a healthy person around natural openings, in the mouth, on the skin of the hands. In 10–30% of healthy women, “silent” carriage of Candida albicans and Candida glabrata in the vagina is found.

At the same time, according to a number of foreign authors (Cox R. A., 1997; Farrington P. E., 1997; Koumantakis E. E., 1997; Vexiau–Robert D., 1996), Candida was in second place among the causative agents of vulvovaginitis in children . According to A.Yu. Sergeeva et al. (2001), Candida albicans is isolated in at least 80% of cases of genital candidiasis and is superior in pathogenicity to other yeast species. Other types of fungi of the species Candida are isolated in 15-30% of cases of vulvovaginal candidiasis. Candida glabrata is the second after Candida albicans the causative agent of vaginal candidiasis, especially in patients who do not respond to the traditionally used treatment with imidazole drugs and, as a result, have a chronic, relapsing course of the disease. Conditional third place in the etiology of vaginal candidiasis mycologists assign Candida tropicalis , less commonly Candida krusei and Candida parapsilosis . It was noted that Candida parapsilosis most often inhabits the skin of the fingers, especially the bed under the free edge of the nails. This property of the fungi has led to an increased risk of transmission of the pathogen through the hands of medical personnel to instruments, syringes, droppers and solutions for parenteral nutrition, artificial endoprostheses, etc.

Accelerated spread of vaginal candidiasis caused by yeast fungi other than Candida albicans , gave rise to the term non-albicans candidiasis (NAC). Some researchers tend to attribute NAC to a complicated fungal infection of the genitals, explaining this interpretation by the frequent association of NAC with a chronic relapsing course of the disease, which is difficult to treat with traditional antimycotic drugs. There are a number of clinical, epidemiological and laboratory characteristics that allow the clinician to diagnose NAC. A similar diagnosis can be assumed in patients with relapses of candidal vulvovaginitis after repeated use of azole antimycotics, in patients complaining of itching with minor or subtle discharge from the genital tract, in girls and girls with manifestations of bacterial vaginosis, if a concomitant sexually transmitted infection is detected, and also in the absence of pseudomycelium of the fungus on microscopy of a vaginal smear.

Clinical picture

According to the course of the disease in children candidiasis, acute, chronic, recurrent and persistent (complicated) form of vulvovaginal candidiasis, as well as secondary candidiasis of the vulva and vagina a, scleroatrophic lichen, etc.).

Candidiasis is diagnosed only in the absence of an increase in the number of fungal colonies in 5–6 bacteriological cultures of the vaginal discharge, successively carried out at weekly intervals. The acute form exists no more than 2 months. The relapsing form should be understood as the presence of 4 or more episodes of vivid clinical manifestations of the disease in one year, alternating with latent periods of candidiasis. In the persistent form, the symptoms of the disease persist constantly, somewhat subsiding after the sanitation of the vagina or the antimycotic treatment.

The main symptoms of the disease in children are pronounced itching in the perineum and burning during urination . Itching can be constant or worse when in a warm bed, after a hot bath, after a long walk, when using synthetic underwear, sanitary pads. In the area of ​​the vulva and labia, itching is usually most intense and is accompanied by scratching. Soreness and burning in young girls can cause fear of urination, and in rare cases lead to the development of clinical manifestations of acute urinary retention. Severe constant itching often leads to sleep disturbance and increased irritability of the girl, up to the appearance of pronounced neurotic reactions. In sexually active adolescents, pain and a burning sensation in the vulva and vagina lead to fear of sexual intercourse, which also contributes to the formation of neurotic disorders and pathological attitudes towards sex.

Examination of a patient with acute candidal vulvovaginitis marked hyperemia and swelling of the external genitalia, vulvar ring and vaginal walls. Slightly creamy or cheesy vaginal discharge has a mild sour smell. Less often, the discharge acquires a watery consistency with an admixture of cheesy crumbs. For children, the pseudomembranous form of the disease, called “thrush” in everyday life, is more characteristic. Between the labia minora, in the vestibule and on the walls of the vagina, islands of a thin grayish-whitish plaque are determined, which, unlike diphtheria lesions of the mucous membranes, is easily removed, exposing bleeding areas of bright hyperemia. Maceration, large red erosive lesions of the skin with a whitish exfoliating epidermis along the periphery (candidal intertrigo), scratching and swelling sometimes extend to the skin of the perineum in the region of the inguinal folds and inner thighs. The affected area has a lilac hue, lacquer sheen, confluent erosions are not accompanied by abundant weeping, are clearly delineated from the surrounding unaffected tissue, small vesicles, pustules or erythematous-squamous elements can be found along the periphery of the foci.

Chronic stages of candidiasis are characterized by less prevalence of lesions, less intense hyperemia and swelling, few plaque films. In menstruating untreated girls, the symptoms of candidal vulvovaginitis resume before the next menstruation and subside somewhat on menstrual days. Chronic forms are characterized by the presence of infiltration and cracks in the clitoris, labia, perineum, and perianal region. Shine and lichenification (rough folds) of the skin of the labia and around the entrance to the vagina appears. Changes in the external genitalia may resemble kraurosis, as the skin and mucous membranes turn brown, become flabby and atrophic, the labia major and minor are smoothed and wrinkled, and the vestibule narrows. With an erythematous (atrophic) variety of chronic candidiasis of the genitals, vaginal discharge and plaque are absent, and spots of thin, hyperemic or slightly cyanotic epithelium are determined on the mucous membrane of the vestibule and walls of the vagina. Along with damage to the genital organs, candidal stomatitis, intestinal candidiasis, and candidal tonsillitis can be detected.

Laboratory diagnostics

Laboratory diagnosis of candidal vulvovaginitis requires direct microscopy of fresh material taken mainly from the anterior wall of the vagina. For microscopy, both unstained native preparations prepared in a drop of saline, and smears stained by Gram, Romanovsky or methylene blue are used. Pay attention to the presence of pseudomycelium and yeast cells, the number of leukocytes, the composition of associates. However, it should be remembered that the detection of vegetative forms (budding cells and pseudomycelium) allows determining the number of fungi, but does not provide information about the pathogenic properties and activity of the infectious process. On the other hand, the absence of pseudomycelia is not always a criterion for excluding candidiasis, since the latter could be caused by other species Candida . Positive results of microscopy correspond to the excess of the content of colony-forming units (CFU) of fungi more than 10 ³ in 1 ml of material. The absence of clinical manifestations in the isolation of more than 10 ⁴ CFU / ml of fungi should be regarded as asymptomatic candidiasis. In the presence of a clinical picture, supported by a positive smear microscopy, candidal lesions of the genitals are beyond doubt. The cultural diagnostic method (as well as the PCR method) does not apply to highly specific and standard methods for diagnosing candidal vulvovaginitis. However, only with the help of these methods is the identification of the genus and species of fungi and an adequate subsequent choice of a systemic antimycotic therapeutic effect possible.

Treatment

For the treatment of children with candidal vulvovaginitis, the principle of mandatory elimination (eradication) of the pathogen is applied. It should be remembered that, first of all, it is necessary to create conditions that are detrimental to the life of the cells of the fungus of the genus Candida , and only then eliminate the disorders of the vaginal microcenosis and correct background conditions and diseases. Moreover, given the easy colonization of Candida , it is important to understand that the complete destruction of fungal cells in vivo is not possible. The expected result of treatment is the removal of the pathogen in order to eliminate the main clinical manifestations, or to block the reproduction of fungi for the duration of one of the factors predisposing to the development of candidal lesions of the mucous membranes (prevention).

So-called local forms are used to prevent colonization of the mucous membranes of the mouth, intestines and vagina. Oral polyene antibiotics (nystatin, amphotericin B, natamycin, levorin) are usually used. These drugs do not have a systemic effect, but only sanitize the intestinal tube, since their absorption in the intestine is minimal. To protect against intestinal hypercolonization by fungi of the genus Candida a good effect is provided by oral administration of imidazole drugs (clotrimazole, ketoconazole, miconazole). It is interesting to note that the use of eubiotics to correct intestinal dysbiosis in vaginal candidiasis has not received clear scientific confirmation, although it is still actively recommended by pediatricians and pediatric gynecologists. Preventive sanitation of the vagina is possible with the help of vaginal tablets, suppositories, gels, solutions and ointments containing any antifungal agents. At the same time, it should be noted that in patients with long-acting and pronounced predisposing factors for candidiasis, polyene antibiotics and local forms are not very effective. The best means of prevention for such patients are antifungal drugs of the triazole series, in particular, itraconazole and fluconazole ( Mikosist etc.).

The mechanism of action of Mycosyst is due to the inhibition of the synthesis of ergosterol, which is part of the cell membrane of fungi. The drug has a highly specific effect on fungal enzymes dependent on cytochrome P450. Treatment with Mycosyst may be initiated until culture and other laboratory results are available , further dose adjustment is necessary. Mycosist in children and adolescents is prescribed in a dose not exceeding the daily dose for adults.

The results of numerous studies indicate a high efficiency (up to 99%) of a single dose of fluconazole in patients with unchanged immunity.

Most cases of acute and severe fungal vulvovaginitis in children and adolescents can be treated with topical antimycotics and antiseptics. The advantage of locally applied drugs is systemic safety, high concentrations of drugs in the lesion, the rapid disappearance of painful symptoms of the disease, and a lower likelihood of developing resistance Candida . Topical preparations are more diverse in composition than systemic antimycotics, since many of them, due to systemic toxicity, are suitable only for local use. According to the source of receipt, all antifungal drugs are distributed to the waste products of microorganisms and synthesized chemicals.

For local treatment of vulvovaginal candidiasis in girls, suppositories with polyene antibiotics (nystatin, levorin, natamycin) and azole preparations (clotrimazole, etc.), which are injected daily into the vagina by a pediatric gynecologist or a nurse trained by him, can be used.

Before the first administration of suppositories or vaginal tablets, it is desirable to irrigate the vagina through a catheter with a solution of baking soda and boric acid, antiseptics with a fungistatic effect (octenisept solution, 2% sodium tetraborate solution, miramistin solution, aqueous solutions of aniline dyes). Long-term use of local antiseptics most often turns out to be ineffective, since the effect of the application ends soon after they are canceled.

Duration of treatment should be 6 days for natamycin and clotrimazole and at least 10 days for nystatin, levorin and miconazole, which is not always acceptable for outpatient management of young girls. Therefore, suppositories with econazole are increasingly used for local treatment of candidal vulvovaginitis in children, which are injected deep into the vagina, 1 suppository at night for 3 days. Gyno-travogen and gyno-trozid, despite their prolonged (up to 1 week) action after a single injection of 1 suppository, turned out to be less popular among pediatric gynecologists, which may be due to alertness to the allergic reactions noted in the annotation and the high cost of drugs. The use of ketoconazole (nizoral) in children is limited due to its pronounced side effects. In patients with vulvovaginitis and severe damage to the skin of the external genital organs, antibiotics and antimycotics can be administered not only deep into the vagina, but also applied in the form of gels and ointments to the vulva, the region of the external opening of the urethra and the perineum.

If there is an association of pathogenic fungi of the genus Candida with other urogenital infections, it is advisable to use combined preparations simultaneously containing an antimycotic and other antimicrobial agents. In the practice of a pediatric gynecologist, it makes sense to use Macmiror-complex (nitrofurantel and nystatin), terzhinan (ternidazole with neomycin, nystatin and prednisolone), polygynax (neomycin, nystatin and polymyxin), klion-D (metronidazole) to eliminate a mixed infection of the lower genital tract. and miconazole nitrate). The use of combined local preparations in some cases avoids the prescription of oral antibiotics that exacerbate vaginal candidiasis.

It is important to note that most topical azole derivatives are not recommended for use in young women who wish to continue their pregnancy. If necessary, their use in the first trimester of the gestational process is allowed. In addition, it should be remembered that the appointment of imidazole derivatives together with polyene antibiotics causes a mutual weakening of the effects.

In girls with chronic, recurrent, complicated or persistent superficial candidiasis, including candidal vulvovaginitis, it is more appropriate combined use of systemic and local forms of antimycotics of the same line, or parallel administration of local antiseptics and fungistatics with systemic antifungal drugs. The advantage of the latter is the convenience of prescribing, minimizing the duration of treatment, as well as the possibility of a highly effective effect on the pathogen at any localization.

Among systemic antimycotics, a special place is occupied by triazole compounds , of which 9 is the most common in Russia0003 fluconazole ( Mikosist etc.). Fluconazole is considered the drug of choice due to its high selective activity against Candida albicans , pharmacokinetics and ease of use. Since triazole compounds are well absorbed, oral administration of the drug should be preferred. Parenteral administration is acceptable if it is impossible to take the drug by mouth. In case of uncomplicated candidal vulvovaginitis, it is enough to use the drug once, and in patients with a torpid or severe course of the disease, the duration of treatment depends on the species of the fungus in the family Candida and from the depth of the lesion. The pediatric dose of the drug for candidiasis of the skin and vagina is 2 mg / kg of body weight of the child, while in children over 12 years of age, a standard daily dose of 50 or 150 mg of fluconazole should be used. The general recommendation for the treatment of complicated forms of genital candidiasis is to increase the duration of the drug in standard doses up to 10-14 days.

It should be remembered that the most common cause of treatment failure candidal vulvovaginitis is the failure to comply with the recommendations of the doctor and the unsystematic self-treatment with local antisepics and antimycotics prior to going to the doctor. The situation was complicated by the penetration of low-quality generics, and sometimes even counterfeit drugs, into the Russian pharmacopoeial market. Along with this, a frequent mistake of the medical stage of managing sick children is ignoring the bacteriological examination of the sowing of the contents of the vagina in order to identify the species of the pathogen and determine its sensitivity to the main antimycotic drugs. The fight against recurrence of fungal vulvovaginitis should include mandatory correction of underlying and predisposing conditions . In this regard, it is of interest to use the immunomodulator Gepon, which has interferon-inducing activity and the ability to quickly eliminate the most characteristic clinical manifestations of candidal vulvovaginitis (itching, soreness, redness of the inflamed tissue significantly decreased already by the 2nd day of the drug). Presumably, Gepon inhibits the production of proteinases by fungal cells, which are one of the leading components of inflammation. According to Perlamutrov Yu.N. and his colleagues (2001), Tishchenko A.L. et al. (2001), triple irrigation of 5 ml of a 0.04% solution of Gepon (single dose of 2 mg) of the mucous membranes of the vagina and perineal skin with an interval of 2–3 days not only had a pronounced clinical anti-inflammatory effect, but also made it possible to achieve a clinical and etiological cure in 84% of patients with genital candidiasis.

The effectiveness of the treatment of candidal vulvovaginitis is established every 10 days of therapeutic exposure, as well as 40 days and 3–4 months after the end of antimycotic etiotropic treatment, taking into account the clinical and laboratory characteristics of the quantitative and species composition of the vaginal biotope and the severity of its colonization by fungi of the genus Candida .

Mycosis of the skin: symptoms, treatment, diagnosis of the disease

Mycoses are an extensive group of diseases united by one symptom – they are all caused by pathogenic fungi that parasitize on the skin, mucous membranes and other human tissues. Among all skin infections, they rank first in terms of prevalence, but despite this, many sick people cannot recognize the disease in time and consult a doctor, which is why dermatologists often have to deal with advanced forms of pathology.

Disease types

Currently, about four hundred different types of fungi are known that can be pathogenic to humans under certain conditions. According to the type of tissues affected, mycoses are distinguished:

• superficial, affecting the skin and mucous membranes:
• deep, the affected area of ​​which is the subcutaneous tissue;
• visceral, which parasitize on the internal organs.

In accordance with the varieties of fungi that parasitize on humans, the following diseases are the most common.

• Rubrophytia. The fungus rubrum trichophyton affects the interdigital spaces, feet, less often settles in the skin folds and on the head. The skin at the site of the lesion turns red and flaky, nodules and small tubercles appear on it. When the skin of the trunk is affected, it forms large patches of reddened skin with bright red concentric ridges.
• Microsporia. As a rule, the fungus is transmitted from sick cats or dogs and affects the fluffy hair on the body, less often – the skin with the formation of a focus of inflamed skin with peeling and vesicles, surrounded by a roller. Microspores are resistant to external influences.
• Trichophytosis. The trichophyton fungus parasitizes on the skin, affecting mainly open areas of the body – the face, hands. It is highly contagious. In humans, outbreaks of the disease are most often recorded in late summer and autumn during field work, when people come into contact with hay and straw, on which the infection was left by sick rodents.
• Lichen versicolor. The cause of the common mycosis of smooth skin is Malassezia furfur. Foci, as a rule, form on the chest and abdomen, less often on other parts of the body: small pink spots appear, the color of which then changes to yellow or brown. They are covered with coarse scales that look like bran. Multiple spots soon merge into large formations.
• Seborrheic dermatitis. This is a common mycosis of the scalp, affecting the scalp, including the skin of the eyebrows, eyelashes, mustache and beard, caused by pityrosporum ovale. A variety of pityrosporum orbicularare parasitizes the smooth skin of the trunk. These are lipophilic fungi that feed on sebum. The affected areas of the skin are marked by inflammation and flaky crusts.
• Candidiasis. Candida yeast-like fungi settle in the skin folds, on the mucous membranes and form reddish spots covered with small bubbles. After a while, eroded areas of bright red color appear in place of the bubbles.

There are many types of mycosis of the skin, subcutaneous tissues and internal organs, which are much less common than the listed types.

Symptoms

It is possible to talk about the symptoms of mycosis only in general terms, since each variety has its own manifestations, which only an experienced dermatologist can recognize. With skin lesions, as a rule, appear:

• reddened and scaly skin;
• severe itching in places affected by the fungus;
• diaper rash in skin folds and interdigital areas;
• small blisters that burst and dry out after a while;
• white, yellow or brownish crusts over inflamed skin.

With mycosis of the limbs, as a rule, the nails also suffer – they become brittle, delaminate, then gradually become cloudy and dark.

Deep mycoses, as a rule, proceed with the formation of deep ulcers, purulent inflammations, fistulas, etc. They are most common in countries with a hot climate, and are extremely rare in Russia. Visceral, depending on the location and degree of damage, can cause dysfunction of the organs on which the fungi parasitize – pulmonary diseases, digestive disorders, etc.

Reasons for the development of pathology

The main cause of mycosis is infection with a pathogenic fungus. At the same time, many types of fungi are constantly present in the body, and their growth is usually restrained by the immune system. With a decrease in control, the fungus begins to grow on the skin or tissues of internal organs. This is often due to:

• chronic disease that weakens the body;
• non-observance of hygiene rules;
• insufficient or unbalanced nutrition;
• smoking and alcohol abuse;
• exposure to external factors that weaken the body – hypothermia, excess ultraviolet radiation, poisoning, radiation damage, etc. ;
• long-term use of antibiotics or certain other medicines.

The only exception here is the so-called fungal mycosis, which is not a fungal disease. This is an oncological tumor pathology, which is based on the degeneration of T-lymphocytes into a malignant form.

Transmission routes

There are many ways to get infected with fungal diseases. Most often this happens:

• in direct contact with the affected skin of another person;
• when sharing towels, slippers, personal hygiene items;
• through a contaminated manicure tool;
• through contaminated clothing and shoes;
• through the soil, especially in the presence of skin microtraumas;
• in contact with pets.

Often, skin mycoses develop in people who visit swimming pools, saunas, showers at sports clubs, etc. Infection is all the more likely, the worse the human immune system works.

Diagnostic methods

As part of the diagnosis of mycoses, studies of scrapings of the skin and nail formations, sputum, blood, hair, scrapings of mucous membranes, feces and other biomaterials can be performed, depending on the type and location of the lesion. For skin diseases, they usually perform:

• dermatoscopy – examination of affected areas of the skin, hair or nails to identify characteristic signs;
• microscopic examination of a scraping to detect fungal mycelium;
• bakposev on nutrient media, which allows you to identify not only the type of fungi, but also the optimal drug for treatment;
• serological examination of blood;
• PCR test for fungal genome detection.

Some types of fungi are quite easily diagnosed using UV radiation, which is generated using a Wood’s lamp.

Simultaneously with determining the type of fungus, the patient is given a general examination to identify the cause of weakened immunity, which led to infection.

Treatment

Currently, there are many means and methods for the treatment of mycosis of almost all types. The main method is drug therapy, which includes drugs of general action and local remedies, which are selected depending on the type of fungus, the degree of damage, the duration of the disease, the patient’s health and other factors. Mycoses of the skin and mucous membranes are best treated: if the doctor’s recommendations are followed, the disease can be eliminated within two to three weeks, and sometimes in just a few days.

With damage to the nails, the course of therapy is several months, and combined treatment is required: local preparations are combined with systemic agents. Local dosage forms are extremely diverse: these are creams, ointments, gels, sprays, nail polishes, powders, drops. Systemic antimycotics are usually available in the form of tablets or capsules. In some cases, complete removal of the affected nail is required.

When choosing drugs, a dermatologist must take into account the individual sensitivity of the pathogen to a particular agent. Self-administration of certain drugs often does not bring the desired result, since before starting treatment it is necessary to determine the type of pathogen. In certain fungal infections, the diet of the patient is important. So, during the treatment of yeast and mold fungi, it is necessary to exclude foods that contain fast carbohydrates (sweets, flour products), fermented foods, alcohol and potatoes.

Prevention

To avoid mycosis, you must:

• observe hygiene rules, especially in public areas;
• avoid contact with stray animals;
• monitor the disinfection of instruments in hairdressing, beauty salons, manicure rooms;
• not to use someone else’s clothes and shoes.

With prolonged use of antibiotics, corticosteroids and immunosuppressants, it is necessary to take antimycotics at the same time.

Diagnosis and treatment of mycosis in Moscow

The clinic of JSC “Medicina” offers reliable, comfortable and high-quality treatment of mycosis. We employ qualified dermatologists with many years of practical experience, the latest medical equipment is used for diagnostics. Modern medical procedures allow you to quickly and reliably cleanse the body of a fungal infection. Call us to make an appointment or register online on our website.

Questions and answers

Which doctor treats mycosis?

For the diagnosis and treatment of mycosis, it is necessary to contact a specialized specialist – a mycologist. However, this medical specialty is quite rare, and in the absence of such a specialist in the clinic, you should visit a dermatologist.

Mycosis – what kind of disease and why is it dangerous?

Mycosis is a fungal infection caused by microscopic fungi. Settling on the tissues of the human body, they feed on them, at the same time destroying what they parasitize – skin, hair, nails, internal organs. At the same time, parasites inhibit the microflora of the body, adjust metabolic processes for themselves and poison the body with waste products of their vital activity. As a result, a person constantly feels unwell, his immune system is weakened, he is easily infected with pathogenic viruses and bacteria, and some people even develop cancer.

How to treat mycosis at home?

There are many traditional medicine recipes for the treatment of fungal infections. They can be used as supplements to fight fungus, but only after the approval of the attending physician.