When A Newborn Presents With A Skin Condition On Both Feet

By Gary “Dock” Dockery, DPM, FACFAS

What You Should Know About Cutaneous Candidiasis

     When a baby develops cutaneous candidiasis this early on, he or she likely picked it up during the birth process. Candida albicans, the most common cause of vaginitis, is more common in women during pregnancy. Reportedly 20 percent of healthy, non-pregnant women have vaginal Candida, and significantly more test positive during pregnancy. Since not all women show symptoms of a vaginal yeast infection, many no doubt are carrying Candida through their births. If the baby picked up Candida during his birth, he may get a cutaneous infection very quickly thereafter. In these cases, the oral cavity and diaper area are usually spared. Involved areas typically include the trunk, palms, soles and may include the cutaneous nail folds.      In full-term infants, isolated cutaneous findings include vesicles, pustules or, most commonly, a widespread erythematous macular rash that resembles a mild drug eruption. Candida albicans is demonstrated with potassium hydroxide (KOH) preparations of skin scrapings or via a Gram stain of pustular or vesicular contents, and is diagnostic. In contrast, congenital candidiasis in premature infants exhibits a more fulminant course and severe cutaneous findings are frequently coupled with invasive pulmonary disease and the precipitous onset of respiratory distress, which may be life-threatening. These more severe cases usually involve premature, low birth-weight infants and one would typically see this condition between the second and sixth weeks of life.      Additionally, if a new mother has a vaginal yeast infection, even if she is being treated with an antifungal, it is very important that she wash her hands frequently with hot, soapy water. This is especially important after visits to the bathroom, after diaper changes and before breastfeeding or pumping since she can spread the infection to her infant. She needs to be on the lookout for any symptoms of nipple thrush, such as suddenly sore nipples, once breastfeeding is well established. It is important to check the baby’s mouth regularly for white plaques that cannot be easily removed. The feet and toes should be scrutinized daily during the first few months of life.

What Is The Differential Diagnosis?

     The differential diagnosis includes intertrigo, miliaria rubra, contact dermatitis, drug eruption, exfoliative dermatitis, tinea pedis, staphylococcal and herpes infections.      Intertrigo is inflammation of skin folds caused by skin on skin friction. Intertrigo may present a similar appearance as diaper rash or candidal infections in infants. The friction in the natural skin folds at the groin, buttocks, under the arms and between the toes can lead to a variety of complications such as secondary bacterial or fungal infections. Managing intertrigo usually involves minimizing moisture and friction with absorptive powders or barrier creams.      Miliaria rubra, or prickly heat, is a common disorder of the eccrine sweat glands that often occurs in conditions of increased heat and humidity. This condition is very common in newborns and infants. It is thought to be caused by a blockage of the sweat ducts. One commonly sees this in the diaper area but it may also occur on the hands and feet, and in any skin fold areas. Secondary infections with yeast, fungi or virus may complicate the condition.      Contact dermatitis and drug reactions are not quite as common but may occur if the baby is exposed to certain chemicals or drugs in the first few days of life.

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