Most diaper rashes have to do with impairment of skin integrity rather than any specific bacterial or fungal infection. Urine and stool acidity (the latter seen in diarrhea) and chronic wetness coupled with a warm barrier environment are all factors proposed as causes of diaper dermatitis (diaper rash). However, sometimes a superficial skin infection is a factor in diaper rash. The most common infectious cause of diaper rash is Candida albicans (yeast, a fungus).
Such a diaper rash can begin with softening and breakdown of the tissue around the anus. The infected area is red and elevated, and fluid may be visible under the skin. Small, raised infected red areas (satellite pustules) appear at the periphery of the rash. These satellite pustules are characteristic of Candida diaper rash and allow yeast diaper rash to be easily distinguished from other types of diaper rash such as a contact (irritant) diaper rash. Yeast diaper rash can appear on the thighs, genital creases, abdomen, and genitals.
Another distribution characteristic of C. albicans diaper distribution is its likelihood to be found in the creases of skin (for example, in the skin folds where the legs join with the pelvis). Generally, contact diaper rash does not involve these regions since the overlapping skin "protects" the area from exposure to noxious irritants.
A Candida skin infection can come from the upper gastrointestinal tract, the lower gastrointestinal tract, or exposure from a care provider. A Candida diaper rash can be accompanied by Candida infection of the mouth (thrush). A breast-feeding infant with a thrush infection may inadvertently infect the mother's nipple/areola area. If such an infection is suspected, simple topical medications may be prescribed by her doctor.
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A prototypical example of irritant contact dermatitis, diaper dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations.
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