Why does my baby have both thrush and a diaper rash? How are they related? These are questions I am frequently asked. Oral thrush is a yeast infection, caused by the yeast Candida albicans. This yeast can also cause a particular type of diaper rash. Thrush is a rash of white, pearly plaques on the inside of the mouth. It is treated with an antifungal agent called nystatin.
There are many types of diaper rash. Candida albicans causes a particular type of rash. It is a raised red rash that spares the creases, or folds, in the skin. It is very common in individuals in diapers, but can be seen in other situations that depress the immune system. It is very painful and itchy. It is also treated with nystatin.
Many infants with thrush go on to develop a candidal diaper rash. Parents often ask why. The mechanism is quite simple. The candida yeast starts in the mouth as thrush. It can then travel through the intestinal tract to come out the bottom. If this happens, your baby will need to be on 2 forms of nystatin. The nystatin is used to treat thrush. nystatin cream or ointment is used on the bottom. How they are used is more of an art than a science. Both medications are frequently given 3-4 times a day. The nystatin suspension is frequently given with a medicine dropper. This is not the best way to administer this drug. Using a medicine dropper treats the candida that is in a line down the center of the tongue, but may not even touch the candida on the insides of the cheeks. It works better if this medication is applied with a cottonswab or your fingertip. This allows you to paint the medication on everywhere that you see the infection. The diaper rash is treated with a thick coating of nystatin cream or ointment. This is often applied three times daily, but can be used every diaper change. Using it more frequently is not associated with any negative side effects, and can cause the rash to go away sooner. On the other hand, if it's 2:00 am and you can't find the diaper cream, it's okay to wait until morning.
Any diaper rash that lasts longer than a week and doesn't respond to over the counter treatment should be seen by your provider. Any rash inside the mouth should be seen in 1-2 days. As always, please contact myself or your child's healthcare provider if you have any questions.
~Dr. Nan N~