Candidal stomatitis (thrush)
The causative agent of candidal stomatitis in infants is opportunistic flora, specifically yeast-like fungi of the genus Candida. The main trigger provoking the development of infection in the neonatal period is inadequate infant care.
Clinical presentation Visual inspection of the newborn's oral mucosa reveals a characteristic, slightly elevated white plaque. A key diagnostic criterion for the disease is identified when attempting to mechanically remove this plaque: it consistently uncovers a hyperemic mucosal surface that bleeds very easily.
Therapeutic tactics Treatment of stomatitis is divided into local and systemic:
- Local treatment: regular oral hygiene. A 0.1% hexetidine solution (Hexoral) or 2% sodium bicarbonate solution is used. The latter is necessary to create an alkaline environment, which is detrimental to fungi. Treatment is performed 2–3 times a day.
- Systemic therapy: prescribed exclusively for a recurrent course of the disease. Oral antimycotics (e.g., fluconazole / Diflucan) are the drugs of choice.
- Extraoral foci: if the infection spreads to the skin or mucous membranes of the urogenital tract, topical therapy is used. Antimycotic creams based on clotrimazole (Canesten, Candid) or isoconazole (Travogen) are prescribed.
Etiopathogenesis of diaper dermatitis
Diaper dermatitis is a multifactorial condition. Skin inflammation is provoked by a complex of factors that exert a combined toxic and irritant effect on the delicate epidermis of the newborn.
An extremely important predisposing background for the manifestation and severe course of dermatitis is the presence of atopic dermatitis in the child.
Main groups of factors:
- Mechanical: constant friction of stiff fabric from diapers or diaper edges against the infant's skin.
- Physical: local increase in temperature and humidity levels, leading to the formation of a so-called "greenhouse effect" in the diaper area.
- Chemical and enzymatic: aggressive chemical action of ammonia contained in urine, as well as bile acid salts present in feces.
- Microbial: overgrowth of resident microflora or secondary infection by pathogens in the closed occlusive zone.
Stages of dermatitis and development of candidiasis
The clinical presentation of diaper dermatitis directly depends on the severity of the pathological process and the duration of trigger exposure.
| Severity | Clinical Manifestations and Localization |
|---|---|
| Mild | Moderate erythema, local rash, and desquamation. Affected areas strictly correspond to the sites of contact with the diaper: buttocks, genitalia, lower back, and lower abdomen. |
| Moderate | Occurs with prolonged exposure to irritants. The lesion deepens: papules, pustules, erosions, and small infiltrates form in the skin folds. There is a high risk of secondary bacterial or fungal superinfection. |
Complicated (candidal) dermatitis If Candida albicans fungi enter the affected area, the disease progresses to a complicated form. A specific sign of such dermatitis is bright erythema with clear boundaries. It involves not only the contact zones but also the inguinal folds, thighs, abdomen, and the genital area. Primary morphological elements in candidal dermatitis are vesicles and papules.
Principles of treatment and care
The treatment of diaper dermatitis requires a comprehensive approach based on the elimination of trigger factors and the restoration of the epidermal barrier function.
- Sanitary and hygienic regimen. Serves as the foundation of treatment. The use of exclusively high-quality, hygroscopic disposable diapers is required. Diaper changes must be frequent (including mandatory changes during the night). Regular washing and bathing of the infant are indicated.
- Barrier therapy. Aims to protect the skin from moisture and chemical irritants. Special protective products are applied under the diaper: zinc oxide-based preparations (Desitin), products with dexpanthenol (Bepanthen), as well as specialized barrier creams (Drapolene).
- Etiotropic therapy. Used only for clinically pronounced or laboratory-confirmed candidiasis. Includes the prescription of topical antifungal drugs in the form of creams or powders.
MPHM: Mechanics (friction), Physics (greenhouse effect), Chemistry (urine ammonia), Microbes (occlusive zone) — 4 factors of pathogenesis.
Class and exam questions
How to reliably confirm candidal stomatitis upon examination?
The diagnostic criterion is the mechanical removal of the white plaque: in thrush, it uncovers a hyperemic, easily bleeding surface of the mucous membrane.
Which areas are primarily affected in mild diaper dermatitis?
Changes occur in areas of direct contact with the diaper: these are the genitalia, buttocks, lower back, and lower abdomen.
What is the characteristic feature of complicated candidal dermatitis?
It is characterized by bright erythema with very clear boundaries that spreads to the inguinal folds, thighs, and abdomen, while the primary elements of the rash are papules and vesicles.
What condition is the main predisposing background for diaper dermatitis?
An important predisposing factor that worsens the course of dermatitis is the presence of atopic dermatitis in the child.
What else to study on this topic
- Mechanism of the toxic effect of bile acid salts on the epidermis
- Pharmacodynamics of local antimycotics (clotrimazole, isoconazole)
- Differential diagnosis of diaper dermatitis and atopic dermatitis
- Features of creating an alkaline environment with sodium bicarbonate
- Morphological characteristics of papules and vesicles in mycoses
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