A 46-day-old boy presented to us with a perigenital and perianal skin
rash for the last 7 days. He was admitted in a neonatal care unit for 24
days for treatment of meningitis. Examination revealed erythematous
erosion involving the perianal and perigenital skin including the
intertriginous creases. There were multiple satellite papules and
pustules scattered over his perineal areas and the thighs (Fig.
1). Systemic examination was non-contributory. Potassium
hydroxide (KOH) preparation of the lesional skin scraping showed
multiple budding yeasts with pseudohyphae. Based on the clinical and
mycological features, a diagnosis of Candidal diaper dermatitis was
made. The lesions responded well to topical clotrimazole cream.
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Fig. 1 Satellite lesions scattered
over perineal area and thighs in Candidal diaper dermatitis.
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Candidiasis in the diaper area is usually
precipitated by the use of antibiotics, or diarrhea of any cause. Common
differential diagnoses are: irritant diaper dermatitis (involves convex
surfaces of inner thigh, lower abdomen, buttock, sparing intertriginous
creases), seborric dermatitis (no satellite papule, involves other
seborric areas including scalp), and inverse psoriasis (well demarcated,
erythematous and glistening plaques with thin white scales, usually
spares inguinal creases, involvement of the other body areas).
