3 – Intertrigo With Group A β-Hemolytic Streptococcal Superinfection
Rarely, children present with skin findings reminiscent of candidal diaper dermatitis but with extensive involvement of noninguinal areas (such as the nuchal, antecubital, and popliteal spaces) (Figure A) and an especially moist-looking appearance without satellitosis. In such cases, it is important to obtain a specimen for culture to check for group A β-hemolytic streptococci. If culture results are positive, initiate treatment with a topical antibiotic ointment, such as mupirocin(Drug information on mupirocin) ointment.
This bacterial infection usually occurs as a complication of intertrigo, a dermatitis that develops in the intertriginous areas of the skin as a result of prolonged or excessive exposure to moisture and an overgrowth of yeast. Thus, treatment also involves keeping these areas dry and applying a topical azole antifungal or wash in addition to the mupirocin to speed resolution. Unless an infant is febrile, oral antibacterial therapy is usually unnecessary.