2 – Candidal or Monilial Diaper Dermatitis
The classic clinical findings in this type of diaper rash are erythema and maceration in the inguinal creases (Figure E). The erythema is often described as "beefy red," and the maceration gives the skin the false appearance of being wet. In addition to involvement of the folds, candidal diaper dermatitis is often associated clinically with the appearance of satellite pustules emanating from the folds and forming a confluent array on the convex skin surfaces. The diagnosis is made almost solely on the basis of the clinical appearance; the history is often unhelpful, and culture is not required for confirmation.
Treatment of candidal diaper dermatitis usually consists of application of one of the topical azole antifungal creams. These agents have broader antifungal coverage than either nystatin(Drug information on nystatin) or other over-the-counter topical antifungal therapies. The inclusion of topical corticosteroid creams in the treatment regimen is almost never necessary and is not advised. Moreover, use of combination creams that contain both antifungal agents and mid-to high-potency topical corticosteroids should be strictly avoided; such creams can be unsafe because they usually contain a higher-potency topical corticosteroid than would otherwise be prudent to use in the groin area—and because the action of the corticosteroid often counteracts the action of the antifungal in the cream.