What causes yeast diaper rash in babies. How to identify and treat fungal diaper rash effectively. Which over-the-counter creams are best for yeast infections in infants. How to prevent recurrence of yeast diaper rash.

Understanding Yeast Diaper Rash: Causes and Prevalence

Yeast diaper rash, a common condition affecting infants and toddlers, is caused by an overgrowth of Candida yeast. This fungus naturally exists on our skin and in our digestive system, but can proliferate under certain conditions, leading to uncomfortable symptoms for babies.

How common is yeast diaper rash? Studies indicate that between 25% and 50% of babies experience some form of diaper rash, with 15% to 50% of these cases attributed to yeast infections. This high prevalence underscores the importance of understanding and effectively managing this condition.

Factors Contributing to Yeast Diaper Rash

• Prolonged exposure to wet or soiled diapers
• Antibiotic use (in baby or breastfeeding mother)
• Thrush (oral yeast infection)
• Warm, moist environment in the diaper area
• Compromised immune system

Can breastfeeding mothers on antibiotics affect their baby’s risk of yeast diaper rash? Indeed, antibiotics in the mother’s system can be passed through breast milk, potentially altering the baby’s natural flora and increasing susceptibility to yeast overgrowth.

Identifying Yeast Diaper Rash: Key Symptoms and Characteristics

Recognizing the distinct features of a yeast diaper rash is crucial for proper treatment. Unlike typical diaper rash, which appears as smooth, chapped skin in the diaper area, yeast infections present with specific symptoms.

Visual Indicators of Yeast Diaper Rash

• Raised, pimple-like sores
• Rash concentrated in skin folds
• Redness and scaling
• Possible clear fluid discharge

Are there differences in yeast diaper rash appearance between baby boys and girls? Yes, there are slight variations. In baby girls, the rash often concentrates on the vulva and may produce yellowish discharge. For baby boys, the infection might cause scaling, redness, or a rash on the penis.

Effective Treatment Options for Yeast Diaper Rash

Treating yeast diaper rash requires a targeted approach using antifungal medications. Over-the-counter creams containing specific active ingredients have proven effective in combating Candida overgrowth.

Recommended Over-the-Counter Antifungal Creams

• Clotrimazole (Lotrimin)
• Miconazole (Monistat Derm)
• Nystatin (Mycostatin)

How long does it typically take to see improvement with antifungal creams? Most parents notice a significant improvement within a couple of days of consistent application. However, if symptoms persist or worsen, it’s essential to consult a pediatrician for further evaluation and possible prescription treatment.

Home Remedies and Supportive Care for Yeast Diaper Rash

In addition to antifungal treatments, several home care strategies can help alleviate symptoms and promote healing of yeast diaper rash.

Effective Home Care Techniques

1. Frequent diaper changes to keep the area dry
2. Thorough cleaning and drying of the affected area
3. Allowing diaper-free time for air exposure
4. Gentle bathing with warm water
5. Avoiding harsh soaps or wipes that may irritate the skin

Why is air exposure beneficial for treating yeast diaper rash? Open air and sunlight create an unfavorable environment for yeast growth. Exposing the affected area to air helps dry out the skin and inhibits fungal proliferation, accelerating the healing process.

Prevention Strategies for Yeast Diaper Rash

Preventing yeast diaper rash involves maintaining proper hygiene and creating an environment that discourages fungal growth. Implementing these preventive measures can significantly reduce the risk of recurrence.

Key Prevention Tips

• Change diapers frequently, especially after bowel movements
• Ensure thorough cleaning and drying during diaper changes
• Use barrier creams or ointments to protect the skin
• Opt for breathable, absorbent diapers
• Consider probiotic supplements (consult with pediatrician first)

How can diaper cream help prevent yeast diaper rash? Diaper cream creates a protective barrier between the baby’s skin and irritants in urine and feces. This barrier reduces moisture contact and helps maintain the skin’s natural pH balance, making it less hospitable for yeast growth.

When to Seek Medical Attention for Yeast Diaper Rash

While many cases of yeast diaper rash can be managed at home, certain situations warrant professional medical evaluation and intervention.

Signs Indicating Need for Pediatric Consultation

• Persistent rash despite home treatment
• Spreading or worsening of the rash
• Development of fever
• Signs of secondary bacterial infection (pus, increased redness, warmth)
• Extreme discomfort or pain for the baby

What treatment options might a pediatrician recommend for severe cases? For persistent or severe yeast diaper rash, a pediatrician may prescribe stronger antifungal medications, such as oral fluconazole or nystatin. They might also recommend combination treatments or address any underlying conditions contributing to the infection.

The Connection Between Thrush and Yeast Diaper Rash

Thrush, an oral yeast infection, and yeast diaper rash are closely related, as both are caused by Candida overgrowth. Understanding this connection is crucial for comprehensive treatment and prevention.

Implications of Thrush-Diaper Rash Connection

• Increased risk of diaper rash in babies with thrush
• Potential for yeast transfer between mouth and diaper area
• Need for simultaneous treatment of both conditions
• Risk of transmission to breastfeeding mothers (nipple thrush)

How can mothers prevent the spread of yeast between themselves and their babies? Practicing good hygiene, such as washing hands thoroughly before and after diaper changes or breastfeeding, can help prevent yeast transmission. Additionally, treating both mother and baby simultaneously when yeast infections are present can break the cycle of reinfection.

Long-Term Management and Care for Recurrent Yeast Diaper Rash

Some babies may be more prone to recurrent yeast diaper rash. In these cases, a long-term management strategy is essential to minimize outbreaks and maintain skin health.

Strategies for Managing Recurrent Yeast Diaper Rash

1. Regular use of preventive barrier creams
2. Consideration of cloth diapers or highly breathable disposable options
3. Dietary adjustments (for older babies) to reduce sugar intake
4. Probiotics to support healthy gut flora
5. Regular check-ups with a pediatrician to monitor and adjust treatment plans

Can dietary changes help prevent recurrent yeast diaper rash in older infants? Yes, reducing sugar intake in a baby’s diet can help create a less favorable environment for yeast growth. For older infants and toddlers, limiting sugary foods and drinks may contribute to a lower risk of yeast overgrowth.

Yeast diaper rash, while common and often uncomfortable for babies, is a manageable condition with proper care and treatment. By understanding its causes, recognizing its symptoms, and implementing effective prevention and treatment strategies, parents can help keep their little ones’ bottoms healthy and rash-free. Remember, persistent or severe cases should always be evaluated by a healthcare professional to ensure the best possible outcome for your baby’s health and comfort.

Yeast Diaper Rash Tips For Freaked Out Parents Of Red Bottomed Babies

Parenting

Updated: July 29, 2021

Originally Published: May 6, 2021

Ruben Earth/Getty

Your baby’s precious bottom is red and angry, and no matter how much cream you slather on and it’s not getting any better. Pee pees bring painful screeches, and you are officially out of ideas to make it stop. Chances are you are dealing with a yeast diaper rash, the pesky, persistent cousin of the run-of-the-mill baby butt rash. We’ve been there, Mama. Anyone who wears a diaper can get a yeast diaper rash, including babies and toddlers. And in most cases, a yeast rash is no biggie if you know how to identify a fungal diaper rash and use the proper treatment.

If you’re beating yourself up because your baby has a yeast diaper rash, know that between a quarter and a half of all babies get some type of diaper rash. Of those, between 15 and 50 percent are due to yeast. It’s really common.

If your little one is howling in pain and you need some tips and answers now, here’s what you need to know.

How do I know if my baby has a yeast diaper rash?

Yeast diaper rash is caused by the same candida yeast that gives babies thrush. Candida is all over our skin, our digestive system, and nether regions, but candida can overgrow when things get out of whack and cause trouble. So first, if the baby is already dealing with thrush, that’s a good clue the diaper rash is yeast-fueled. And nursing mothers on antibiotics are not just at risk of yeast infections themselves, babies drinking the breastmilk might feel some of the same effects. So if antibiotics are in the baby’s system, they may be more susceptible to a fungal diaper rash.

Heads up, if you think your baby has thrush, they can pass it back to you; nipple thrush is a thing. Sorry!

What does a yeast diaper rash look like?

Regular diaper rash is smooth, has the appearance of chapped skin, is isolated in the general diaper area, and goes away after a few passes with diaper rash cream. A yeast infection rash will typically have raised sores that look like little pimples and will be located in the folds of the skin rather than on the smooth flat areas like butt cheeks.

— Baby girl yeast diaper rash: A baby girl’s yeast rash will tend to concentrate on the vulva and, like any other itchy, burning vaginal yeast infection, might produce some yellowish discharge.

— Baby boy yeast diaper rash: A baby boy’s yeast infection might cause scaling, redness, or a rash on the penis.

Candidiasis yeast overgrowth could also cause patches that ooze clear fluid, cracks or fissures around the corners of the mouth or swelling, pain, or even pus coming out of the nail beds, per the University of Rochester Medical Center.

How do you treat a yeast diaper rash?

Number one: you know your baby better than anyone else. If they start running a fever or if the rash keeps getting bigger, take them to see the pediatrician and get a prescription.

If you’re looking for a topical, at-home fix, even the best diaper rash cream won’t help. It would be best if you had an antifungal like Clotrimazole antifungal cream, the active ingredient in Lotrimin, Monistat Derm (which contains miconazole micatin), and Mycostatin with nystatin, which you can find at the pharmacy. Some of these options can be found in the “athlete’s foot” section. Athlete’s foot is a fungus, too, along with ringworm. It goes without saying you should always consult with your pediatrician before using any over-the-counter creams. You should also make sure the baby’s tender skin can tolerate the cream before applying. You should start to see improvement after a couple of days. If not, head to the pediatrician.

While treating fungus with creams, remember those itchy little buggers love warm, dark, moist places — like diapers. Give baby a thorough bath to clean the rash, and then make sure you dry their little undercarriage completely before putting a diaper back on them.

Better yet, lose the diaper altogether and let their little bum breathe for the ultimate free spirit treatment. Open air and sunlight are fungus Kryptonite. When going commando isn’t an option, make sure to keep diaper changing on the reg to keep things dry and clean while that precious tooshie heals.

How to prevent yeast diaper rash?

The best way to keep your baby safe from yeast diaper rash is to keep their bottoms dry and well taken care of. Here are a few tips to protect your baby and their booties.

• Bathe your child in warm water.
• After changing the baby, allow their bottoms to air dry before putting another diaper on them.
• Give your baby some diaper-free time!
• Try to stay on top of their changing schedule. Don’t leave your baby in a dirty diaper for too long.
• Use diaper cream on your baby’s bottom to protect them from their excretions, which can cause rashes.
• In addition to wiping your baby, clean them with water during diaper changes.
• Avoid putting their diapers on too tight. Make sure they have breathing room down there.
• Invest in super absorbent diapers to keep your baby’s skin as dry as possible.
• If your child uses cloth diapers, when you wash and dry them avoid using fabric softeners or dryer sheets.
• When wiping your little one during diaper changes, don’t use baby wipes that are heavily scented with perfumes.
• Make sure you wash your hands before and after each diaper change.
• Avoid putting your baby in rubber bottoms because it traps moisture in the skin.

Are there yeast diaper rash home remedies?

If you want to use natural remedies for your baby’s bottom there are a few options you can try. But before using any of these home solutions, run them by your doctor first.

• Try dabbing the area with breast milk. It has anti-infective qualities and antibodies, which can help reduce irritation.
• Make your own antifungal cream by mixing olive oil, shea butter, coconut oil, and zinc oxide. This will help soothe any soreness.

This article was originally published on May 6, 2021

Antifungal agents for common paediatric infections

1. Gupta AK, Cooper EA, Ryder JE, Nicol KA, Chow M, Chaudhry MM. Optimal management of fungal infections of the skin, hair, and nails. Am J Clin Dermatol. 2004;5:225–37. [PubMed] [Google Scholar]

2. Canadian Paediatric Society, Infectious Diseases and Immunization Committee [Principal Author: S King] Antifungal agents for common paediatric infections. Paediatr Child Health. 2000;5:477–82. [PMC free article] [PubMed] [Google Scholar]

3. Linder N, Levit O, Klinger G, et al. Risk factors associated with candidaemia in the neonatal intensive care unit: A case-control study. J Hosp Infect. 2004;57:321–4. [PubMed] [Google Scholar]

4. Yamamura DL, Rotstein C, Nicolle LE, Ioannou S. Candidemia at selected Canadian sites: Results from the Fungal Disease Registry, 1992–1994. CMAJ. 1999;160:493–9. [PMC free article] [PubMed] [Google Scholar]

5. Clarkson JE, Worthington HV, Eden OB. Interventions for treating oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2004;(1):CD001972. [PubMed] [Google Scholar]

6. Butler KM, Baker CJ. Candida: An increasingly important pathogen in the nursery. Pediatr Clin North Am. 1988;35:543–63. [PubMed] [Google Scholar]

7. Baley JE, Kliegman RM, Boxerbaum B, Fanaroff AA. Fungal colonization in the very low birth weight infant. Pediatrics. 1986;78:225–32. [PubMed] [Google Scholar]

8. Sio JO, Minwalla FK, George RH, Booth IW. Oral candida: Is dummy carriage the culprit? Arch Dis Child. 1987;62:406–8. [PMC free article] [PubMed] [Google Scholar]

9. Faber HK, Dickey LB. The treatment of thrush with gentian violet. JAMA. 1925;85:900–1. [Google Scholar]

10. Huang NN, Sarria A, High RH. Therapeutic evaluation of nystatin and amphotericin in oral moniliasis in infants and children. Antibiot Annu. 1957–1958;5:59–64. [PubMed] [Google Scholar]

11. Boon JM, Lafeber HN, Mannetje AH, et al. Comparison of ketoconazole suspension and nystatin in the treatment of newborns and infants with oral candidiasis. Mycoses. 1989;32:312–5. [PubMed] [Google Scholar]

12. Hoppe JE. Treatment of oropharyngeal candidiasis in immunocompetent infants: A randomized multicenter study of miconazole gel versus nystatin suspension. The Antifungals Study Group. Pediatr Infect Dis J. 1997;16:288–93. [PubMed] [Google Scholar]

13. Kirkpatrick CH, Alling DW. Treatment of chronic oral candidiasis with clotrimazole troches. A controlled clinical trial. N Engl J Med. 1978;299:1201–3. [PubMed] [Google Scholar]

14. Mansour A, Gelfand EW. A new approach to the use of antifungal agents in children with persistent oral candidiasis. J Pediatr. 1981;98:161–2. [PubMed] [Google Scholar]

15. Grossman ER. Treatment of thrush. Pediatr Infect Dis J. 1988;7:303. [PubMed] [Google Scholar]

16. Rebora A, Leyden JJ. Napkin (diaper) dermatitis and gastrointestinal carriage of Candida albicans. Br J Dermatol. 1981;105:551–5. [PubMed] [Google Scholar]

17. Concannon P, Gisoldi E, Phillips S, Grossman R. Diaper dermatitis: A therapeutic dilemma. Results of a double-blind placebo controlled trial of miconazole nitrate 0.25% Pediatr Dermatol. 2001;18:149–55. [PubMed] [Google Scholar]

18. Dixon PN, Warin RP, English MP. Alimentary Candida albicans and napkin rashes. Br J Dermatol. 1972;86:458–62. [PubMed] [Google Scholar]

19. Munz D, Powell KR, Pai CH. Treatment of candidal diaper dermatitis: A double-blind placebo-controlled comparison of topical nystatin with topical plus oral nystatin. J Pediatr. 1982;101:1022–5. [PubMed] [Google Scholar]

20. Schwartz RA. Superficial fungal infections. Lancet. 2004;364:1173–82. [PubMed] [Google Scholar]

21. Gupta AK, Batra R, Bluhm R, Faergemann J. Pityriasis versicolor. Dermatol Clin. 2003;3:413–29. [PubMed] [Google Scholar]

22. Ginsberg CM. Malassezia species. In: Long SS, Pickering LK, Prober CG, editors. Principles and Practice of Pediatric Infectious Diseases. New York: Churchill Livingston; 1997. pp. 1337–8. [Google Scholar]

23. Mellen LA, Vallee J, Feldman SR, Fleischer AB., Jr Treatment of pityriasis versicolor in the United States. J Dermatolog Treat. 2004;15:189–92. [PubMed] [Google Scholar]

24. Gupta AK, Einarson TR, Summerbell RC, Shear NH. An overview of topical antifungal therapy in dermatomycoses. A North American perspective. Drugs. 1998;55:645–74. [PubMed] [Google Scholar]

25. Lange DS, Richards HM, Guarnieri J, et al. Ketoconazole 2% shampoo in the treatment of tinea versicolor: A multicenter, randomized, double-blind, placebo controlled trial. J Am Acad Dermatol. 1998;39:944–50. [PubMed] [Google Scholar]

26. Ginsberg CM. Dermatophytes and other superficial fungi. In: Long SS, Pickering LK, Prober CG, editors. Principles and Practice of Pediatric Infectious Diseases. New York: Churchill Livingston; 1997. pp. 1359–62. [Google Scholar]

27. Gupta AK, Sibbald RG, Lynde CW, et al. Onychomycosis in children: Prevalence and treatment strategies. J Am Acad Dermatol. 1997;36:395–402. [PubMed] [Google Scholar]

28. Bräutigam M. Terbinafine versus itraconazole: A controlled clinical comparison in onychomycosis of toenails. J Am Acad Dermatol. 1998;38:S53–6. [PubMed] [Google Scholar]

29. De Backer M, De Vroey C, Lesaffre E, Scheys I, De Keyser P. Twelve weeks of continuous oral therapy for toenail onychomycosis caused by dermatophytes: A double-blind comparative trial of terbinafine 250 mg/day versus itraconazole 200 mg/day. J Am Acad Dermatol. 1998;38:S57–63. [PubMed] [Google Scholar]

30. Grant SM, Clissold SP. Fluconazole: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial and systemic mycoses. Drugs. 1990;39:877–916. (Erratum in 1990;40:862) [PubMed] [Google Scholar]

31. Gatti S, Marinaro C, Bianchi L, Nini G. Treatment of kerion with fluconazole. Lancet. 1991;338:1156. [PubMed] [Google Scholar]

32. Solomon BA, Collins R, Sharma R, et al. Fluconazole for the treatment of tinea capitis in children. J Am Acad Dermatol. 1997;37:274–5. [PubMed] [Google Scholar]

33. López-Gómez S, Del Palacio A, Van Cutsem J, Soledad Cuétara M, Iglesias L, Rodriguez-Noriega A. Itraconazole versus griseofulvin in the treatment of tinea capitis: A double-blind randomized study in children. Int J Dermatol. 1994;33:743–7. [PubMed] [Google Scholar]

34. Legendre R, Esola-Macre J. Itraconazole in the treatment of tinea capitis. J Am Acad Dermatol. 1990;23:559–60. [PubMed] [Google Scholar]

35. Lukacs A, Korting HC, Lindner A. Successful treatment of griseofulvin-resistant tinea capitis in infants. Mycoses. 1994;37:451–3. [PubMed] [Google Scholar]

36. Elewski BE. Tinea capitis: Itraconazole in Trichophyton tonsurans infection. J Am Acad Dermatol. 1994;31:65–7. [PubMed] [Google Scholar]

37. Greer DL. Treatment of tinea capitis with itraconazole. J Am Acad Dermatol. 1996;35:637–8. [PubMed] [Google Scholar]

38. Tanz RR, Stagl S, Esterly NB. Comparison of ketoconazole and griseofulvin for the treatment of tinea capitis in childhood: A preliminary study. Pediatr Emerg Care. 1985;1:16–8. [PubMed] [Google Scholar]

39. Tanz RR, Hebert AA, Esterly NB. Treating tinea capitis: Should ketoconazole replace griseofulvin? J Pediatr. 1988;112:987–91. [PubMed] [Google Scholar]

40. Gan VN, Petruska M, Ginsburg CM. Epidemiology and treatment of tinea capitis: Ketoconazole vs griseofulvin. Pediatr Infect Dis J. 1987;6:46–9. [PubMed] [Google Scholar]

41. Martinez-Roig A, Torres-Rodriguez JM, Bartlett-Coma A. Double-blind study of ketoconazole and griseofulvin in dermatophytoses. Pediatr Infect Dis J. 198;7:37–40. [PubMed] [Google Scholar]

42. Faergemann J, Zehender H, Denouël J, Millerioux L. Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once per day for four weeks. Acta Derm Venerol. 1993;73:305–9. [PubMed] [Google Scholar]

43. McClellan KJ, Wiseman LR, Markham A. Terbinafine. An update of its use in superficial mycoses. Drugs. 1999;58:179–202. [PubMed] [Google Scholar]

44. Haroon TS, Hussain I, Mahmood A, Nagi AH, Ahmad I, Zahid M. An open clinical pilot study of the efficacy and safety of oral terbinafine in dry non-inflammatory tinea capitis. Br J Dermatol. 1992;126(Suppl 39):47–50. [PubMed] [Google Scholar]

45. Nejjam F, Zagula M, Cabiac MD, Guessous N, Humbert H, Lakhdar H. Pilot study of terbinafine in children suffering from tinea capitis: Evaluation of efficacy, safety and pharmacokinetics. Br J Dermatol. 1995;132:98–105. [PubMed] [Google Scholar]

46. Alvi KH, Iqbal N, Khan KA, et al. A randomized double-blind trial of the efficacy and tolerability of terbinafine once daily compared to griseofulvin once daily in treatment of tinea capitis. In: Shuster S, Jafary MH, editors. Royal Society of Medicine Services International Congress Series, no 205. London: Royal Society of Medicine Press Ltd; 1992. pp. 35–40. [Google Scholar]

47. Haroon TS, Hussain I, Aman S, et al. A randomized double-blind comparative study of terbinafine for 1, 2 and 4 weeks in tinea capitis. Br J Dermatol. 1996;135:86–8. [PubMed] [Google Scholar]

48. Kullavanijaya P, Reangchainam S, Ungpakorn R. Randomized single-blind study of efficacy and tolerability of terbinafine in the treatment of tinea capitis. J Am Acad Dermatol. 1997;37:272–3. [PubMed] [Google Scholar]

49. Gupta AK, Cooper EA, Lynde CW. The efficacy and safety of terbinafine in children. Dermatol Clin. 2003;21:511–20. [PubMed] [Google Scholar]

50. Albengres E, Le Louet H, Tillement JP. Systemic antifungal agents. Drug interactions of clinical significance. Drug Saf. 1998;18:83–97. [PubMed] [Google Scholar]

51. Howard RM, Frieden HJ. Dermatophyte infections in children. In: Aronoff SC, Hughes WT, Kohl HS, Prince A, editors. Advances in Pediatric Infectious Diseases, Vol 14. St Louis: Mosby-Year Book; 1999. pp. 73–108. [Google Scholar]

Treatment of vulvovaginal candidiasis: analysis of foreign recommendations

05/08/2016

PDF article.

Vulvovaginal candidiasis (VVC) is an infection of the mucosa of the vulva and vagina caused by fungi of the genus Candida and develops annually in millions of women worldwide. It is believed that up to 75% of women experience at least one episode of uncomplicated VVC at some time in their lives, and 40-45% – two episodes or more (J.D. Sobel, 2007). Although the main causative agent of VVC today is Candida albicans , in recent years, other species of fungi of the genus Candida ( Candida non-albicans ), in particular Candida glabrata , have been increasingly identified as the cause of VVC (B. Goncalves et al., 2015). The clinical significance of this fact lies in the fact that Candida non-albicans fungi are characterized by greater resistance to first-line antifungal drugs (A. L. Tikhomirov, Ch.G. Oleinik, 2009; M. Ilkit, A.B. Guzel, 2011).

There are several factors associated with the state of the body of a woman, predisposing to the development of VVC. These include pregnancy, uncontrolled diabetes mellitus, immunosuppression, the use of antibiotics and glucocorticoids, as well as genetic predisposition. Risk factors for the development of VVC associated with the lifestyle of a woman are the use of oral contraceptives, intrauterine devices, spermicides and condoms, as well as some features of hygiene and sexual behavior.

Of course, among the listed risk factors, special attention of obstetricians-gynecologists requires pregnancy – the physiological state of the woman’s body, which, nevertheless, predisposes to the development of clinically manifest VVC. This is primarily due to immunological and hormonal changes characteristic of pregnancy, as well as increased vaginal glycogen production during this period. According to the data of microbiological studies, fungi of the genus Candida colonize the vagina without the development of corresponding clinical symptoms in at least 20% of women, and during pregnancy this figure increases to 30%. Recently, interesting data have also appeared that VVC during pregnancy may be associated with an increased risk of complications such as premature rupture of the membranes and preterm labor, chorioamnionitis, and congenital skin candidiasis in newborns (T.J. Aguin, J.D. Sobel, 2015). Most episodes of symptomatic VVC develop during the second and third trimesters of pregnancy. The choice of means for its treatment is a very important task, since in this clinical situation the doctor must, on the one hand, avoid the systemic effect of drugs on the fetus, and on the other hand, ensure rapid relief of the symptoms of the disease and effective sanitation of the vagina from fungi of the genus Candida .

The main clinical manifestations of VVC are thick, white, cheesy discharge with a sour smell, itching and burning in the vulva, edema and hyperemia of the mucous membrane of the vulva and vagina, dysuria and dyspareunia. In acute VVC, itching in most cases reaches high intensity, disrupting the patient’s sleep and rest, leading to the formation of insomnia and neuroses.

According to the modern classification, the following forms of VVC are distinguished (V.N. Serov, 2014):

• sharp;
• chronic : recurrent (≥4 episodes within 12 months) and persistent.

According to the types of flow, uncomplicated and complicated VVC are distinguished.

Uncomplicated VVC implies:

• isolated or rare cases;
• mild or moderate course;
• caused by Candida albicans ;
• without impaired immunity in the patient.

Complicated VVC is diagnosed in the following cases:

• for relapse;
• for severe forms;
• when infected Candida non-albicans ;
• with concomitant conditions: decompensated diabetes mellitus, other serious illnesses, pregnancy, immunosuppression.

Treatment is provided to those patients with complaints and clinical symptoms in whom the diagnosis of VVC is confirmed by the detection of Candida spp . during laboratory research. For the etiotropic treatment of VVC, both systemic and local antifungal drugs of various groups are used, mainly polyene, imidazole or triazole series. Currently, the arsenal of obstetricians-gynecologists has a wide range of antifungal drugs indicated for the treatment of patients with VVC and presented in various dosage forms. The choice of treatment regimens and the work of practitioners greatly facilitates the availability of clinical guidelines for certain problems and diseases based on evidence-based medicine. Therefore, it is important to analyze the current recommendations for the treatment of patients with VVC, adopted in the developed countries of the world.

European Union – IUSTI/WHO guidelines (2011)

The treatment of VVC is detailed in the European guidelines for the management of patients with abnormal vaginal discharge issued by the International Union against Sexually Transmitted Infections (IUSTI) and WHO in 2011 (Sherrard J. , Donders G., White D. European (IUSTI/WHO) Guideline on the Management of Vaginal Discharge, 2011). This document indicates that intravaginal antifungal agents and oral preparations provide the same treatment efficacy in VVC. Treatment with drugs that are derivatives of the azole leads to relief of symptoms and negative culture results in 80-90% of patients after completion of the course of therapy (regardless of whether the drug was used orally or topically). In general, standard single oral dose preparations are as effective as longer courses. It has been proven that in an episode of severe symptomatic VVC, in terms of symptom relief, repeated administration of fluconazole at a dose of 150 mg 3 days after its first administration is more effective.

The European Guidelines for the Management of Patients with Pathological Vaginal Discharge (2011) list the following antifungal agents recommended for use in the treatment of VVC:

• oral preparations:

– fluconazole 150 mg once;

– itraconazole 200 mg 2 r / day – 1 day.

• preparations intended for intravaginal administration:

– Clotrimazole in the dosage form of vaginal tablets 500 mg 1 r / day or 200 mg 1 r / day for 3 days;

– miconazole (vaginal ovulation) 1200 mg once or 400 mg 1 r / day for 3 days;

– econazole in the form of a vaginal pessary 150 mg once.

The guidelines state that there is no strong evidence that topical treatment of the vulvar mucosa provides any additional benefit beyond intravaginal treatment, although some patients with VVC prefer it. In a clinical situation, when VVC is accompanied by severe itching, faster symptomatic relief can be achieved by applying topical preparations containing hydrocortisone to the mucous membrane. Additional use of moisturizing creams (emollients) in patients receiving systemic oral antifungal therapy may be of some benefit. They are affordable and rarely cause mucosal irritation reactions.

During pregnancy only topical antifungals are allowed. Nystatin, which is a non-azole derivative (a polyene antifungal), provides a cure for infection caused by fungi of the genus Candida in 70-90% of cases, but it may be useful in women with reduced sensitivity to azole drugs. The dose in the dosage form of the pessary is 100,000 IU (1-2 pessaries per night for 14 nights). However, this drug is not available in all European countries.

Chronic VVC caused by C. glabrata , requires a longer course of treatment. The first line of therapy is the use of nystatin for 21 days and topical flucytosine (in monotherapy or in combination with topical amphotericin). Boric acid can also be used in the form of vaginal suppositories 600 mg per day for 14-21 days. Response to treatment should be assessed on the basis of culture data, since it can sometimes take several months to achieve a symptomatic response.

In the treatment of recurrent VVC (≥4 symptomatic episodes per year), an important role is played by the exclusion of risk factors (eg, diabetes mellitus, immunodeficiency, glucocorticoid therapy, frequent use of antibiotics). An initial intensive treatment for 10-14 days is recommended, followed by maintenance therapy (weekly for 6 months). Since vulvar dermatitis/eczema is a typical problem in recurrent VVC, it is recommended that a moisturizing cream be applied to the dry skin of this area, which is then washed off and acts as a substitute for soap. Suppression of ovulation with the help of progestins may be of some benefit in recurrent VVC.

United States of America – CDC (2015) recommendations

In 2015, the US Centers for Disease Control and Prevention (CDC) issued an updated Guideline for the Treatment of Sexually Transmitted Diseases (Workowski K.A., Bolan G.A. MMWR Recomm Rep 2015; 64). A separate section in this document is devoted to VVC. According to these recommendations , for uncomplicated VVC , a short course of treatment with topical antifungal drugs applied once or for 1-3 days should be used. At the same time, the recommendations emphasize that topical azole antifungals are more effective than nystatin in uncomplicated VVC. Treatment with azole derivatives leads to symptomatic relief and negative culture results in 80-90% of patients who completed the course of therapy.

However, the guidelines note that creams and suppositories are oil-based formulations, which may increase the likelihood of failure of latex condoms and diaphragms. Women who have symptoms persist after OTC use or relapse within 2 months of VVC treatment should be carefully evaluated clinically and microbiologically, as inappropriate use of OTC antifungals may lead to delays in treatment of other vulvovaginitis etiologies and, consequently, to unfavorable outcomes.

The pathogenesis of recurrent VVC is not well understood; most of these patients have no obvious predisposing factors or underlying diseases. In 10-20% of women with recurrent VVC, C. glabrata and other fungal species Candida non-albicans are found on culture, which are less sensitive to traditional antifungal therapy than C. albicans .

For each individual episode of recurrent VVC caused by C. albicans , there is an effective response to a short course of therapy with oral or topical azole preparations. However, to maintain clinical and mycological control, some experts recommend using longer initial therapy (topical therapy for 7-14 days or oral fluconazole at a dose of 100, 150 or 200 mg every 3 days until a total of 3 doses is reached, that is, 1 , days 4 and 7 of treatment) to achieve mycological remission before starting a maintenance antifungal regimen.

First-line maintenance treatment for recurrent VVC is oral fluconazole (100, 150, or 200 mg) weekly for 6 months. If this maintenance regimen is not feasible, intermittent topical antifungals may be considered. Suppressive maintenance therapy is quite effective in reducing the frequency of VVC recurrence, however, 30-50% of patients relapse after its termination.

Severe vulvovaginal candidiasis (accompanied by widespread vulvar erythema, edema, excoriation, and fissuring) is associated with a lower clinical response rate in patients treated with short courses of topical or oral therapy. In this situation, it is recommended to use a topical azole drug for 7-14 days or oral fluconazole 150 mg in two consecutive doses (the second dose 72 hours after the initial one).

Optimal regimen for fungal VVC Candida non-albicans Not established. Treatment options include extending the duration of therapy (7-14 days) with oral or topical azoles (but not fluconazole) as first choice. In case of recurrence of the disease, intravaginal administration of boric acid at a dose of 600 mg in the form of gelatin capsules 1 r / day for 2 weeks is recommended. The rate of clinical cure and microbiological eradication with this treatment regimen is about 70%.

For the treatment of VVC during pregnancy, CDC guidelines explicitly state that only topical azoles are recommended for 7 days in pregnant women.

Germany – recommendations DGGG, AGII and DDG (2015)

In 2015, the German Society of Obstetricians and Gynecologists (DGGG), the Working Group on Infections and Immunology in Obstetrics and Gynecology (AGII) and the German Dermatological Society (DDG) developed Recommendations for the diagnosis and treatment of VVC (except for chronic candidiasis of the skin and mucous membranes). meninges, Mendling W., Brasch J., Cornely O.A. Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses. 2015 Mar; 58 Suppl 1:1-15). They consider a large number of traditional schemes and alternative methods of treating VVC. It is emphasized that even with a high fungal count, asymptomatic vaginal colonization does not require treatment, provided that the patient is immunocompetent and does not suffer from chronic recurrent VVC. Acute VVC German experts recommend treating with topical drugs – polyenes (nystatin), imidazoles (clotrimazole, miconazole, econazole, fenticonazole) or ciclopiroxolamine (Table 1).

As can be seen from the table, a wide range of vaginal suppositories and creams are available on the German pharmaceutical market in various dosages, which, when administered in the recommended course (1-7 days), are considered safe for patients. Oral triazole therapy, either fluconazole or itraconazole, is also possible. Mycological and clinical cure rates for different drugs in non-pregnant patients are practically the same and are approximately 85% after 1-2 weeks and 75% after 4-6 weeks after treatment.

In pregnant women with VVC , imidazoles are significantly more effective than polyenes. Interestingly, the German guidelines recommend prophylactic treatment of asymptomatic Candida vaginal colonization in the last 6 weeks of pregnancy in order to prevent colonization and subsequent infection of the newborn. After the implementation of this recommendation, the frequency of thrush and diaper dermatitis in the first 4 weeks of life decreased from 10 to 2%. In addition, in a series of retrospective and one prospective studies, a significant reduction in the incidence of preterm birth was observed after intravaginal clotrimazole therapy in the first trimester of pregnancy.

In chronic recurrent VVC , caused by C. albicans , topical or systemic maintenance therapy is recommended to prevent recurrence. Intravaginal clotrimazole 500 mg, oral ketoconazole 100 mg, and oral fluconazole 150 mg provide comparable efficacy.

Canada – SOGC recommendations (2015)

Van Schalkwyk J., Yudin M.H. Vulvaginitis: Screening for and Management of Trichomoniasis, Vulvovaginal Candidiasis and Bacterial Vaginosis J Obstet Gynaecol Can 2015; 37(3): 266-274). Canadian experts agree with their European and American colleagues that VVC should only be treated if clinical symptoms are present. Detection of yeast fungi in a wet anatomical preparation, Gram-stained smear/culture or Pap smear in the absence of associated symptoms does not require therapy. Information about treatment options and dosing of drugs used in therapy of uncomplicated VVC, recurrent VVC and VVC caused by Candida non-albicans strains are presented in Table 2 (M. Nurbai et al., 2007; J.D. Sobel et al., 2004; P.G. Pappas et al., 2004; S Guaschino et al., 2001; J. D. Sobel et al. , 1986; A. C. Roth et al., 1990).

For the treatment of VVC in pregnant women, SOGC experts recommend the use of topical azoles only. Topical imidazole creams and intravaginal suppositories may be required for up to 14 days. Repeated courses of treatment may also be needed. During pregnancy, oral fluconazole should be avoided, as this may increase the risk of tetralogy of Fallot in the fetus (D. Molgaard-Nielsen et al., 2013). The safety of oral fluconazole in the second and third trimesters of pregnancy has not been studied. Intravaginal administration of boric acid has been associated with a more than 2-fold increase in the risk of congenital malformations of the fetus when used during the first 4 months of pregnancy (N. Acs et al., 2006), so it is recommended to avoid it at this gestational age.

***

Thus, to date, a sufficient evidence base has been accumulated regarding a significant number of antifungal drugs that can effectively treat women with various forms of VVC, including during pregnancy. With the exception of minor differences related to the characteristics of drugs presented in a particular region, in general, the developed countries of the world have adopted agreed algorithms for treatment interventions. When analyzing the recommendations for the diagnosis and treatment of VVC, valid in different countries, attention is drawn to the possibility of widespread use of local antifungal drugs in various dosage forms as first-line therapy. This is due to the fact that local preparations for VVC therapy create a high concentration on the mucous membrane and provide rapid relief of clinical symptoms. It should also be noted that the appointment of topical antifungal drugs is a non-alternative treatment option for pregnant women with VVC, since no current guidelines recommend the use of systemic antifungal agents intended for oral administration in this special population of patients. We hope that when managing patients with VVC, practicing gynecologists will more often refer to international clinical guidelines in order to make optimal and informed clinical decisions.

Prepared by Elena Tereshchenko

Thematic issue “Gynecology, Obstetrics, Reproductology” No. 1 (21) February 2016

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• Thematic issue “Gynecology, Obstetrics, Reproductology” No. 1 (21) February 2016

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