Candida albicans and napkin dermatitis: relationship and lesion severity correlation

  • Amani Hussein Ahmed Karsani Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia
  • Abdullateef Azolaibani Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia,Department of Dermatology, College of Medicine, Qassim University, Saudi Arabia
  • Yasser Farouq Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia
  • Khalid Zedan Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia
  • Mohammed Mohsen Alotaibi Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia,Department of Pathology and Laboratory Medicine, College of Medicine, Qassim University, Saudi Arabia
  • Ghada Bin Saif Dermatology Department, College of Medicine, King Saud University
  • Ibrahim H. Babikir Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia,Department of Pathology and Laboratory Medicine, College of Medicine, Qassim University, Saudi Arabia
Keywords: Candida albicans, Napkin dermatitis, Diaper dermatitis, Vitek 2 compact system, Qassim

Abstract

Introduction: Napkin Dermatitis (ND) is a common problem in infancy that affects almost every child during the early months and years of their lifetime. It is a skin disease that becomes a challenge for both parents and physicians because of its frequency and difficulty in eliminating all of the causative factors in diapered infants. Usually Napkin dermatitis is self-limiting but when associated with Candida albicans (C. albicans) seems to be moderate to severe.

Aim: The aim of the present study was to determine the colonization of C. albicans in children with Napkin dermatitis and to correlate between intensity of C. albicans colonization and the severity of napkin rash.

Patients and Methods: This case-controlled study was conducted at Qassim University pediatric outpatient clinics, during the period from August 2014 to July 2015. Sixty patients with diaper dermatitis and 33 healthy controls were enrolled to this study. Sociodemographic and clinical data were obtained from the parents of each participant using questionnaires Paired (stool and skin) samples were collected from all cases and healthy control children. The samples were cultured on differential and selective chromogenic medium for isolation and initial identification of candida species. Identification confirmation of the isolates was determined by the Vitek 2 compact automated system.

Results: Diaper dermatitis shows significant outcome to washing diaper area (per day) (P = 0.001), History of diarrhea last 7 Days (P < 0.001), skin lab results (+/-) for Candida albicans, (P < 0.001), skin colony count, (P < 0.001), However, there is no correlation to age (P = 0.828), gender (P = 0.368) and feeding style (P = 0.401).

Conclusion: The severity score of napkin dermatitis was significantly observed among cases with diaper dermatitis (p-value < 0.001) and control children (p-value < 0.001) respectively.

References

[1] R. Fölster-Holst, M. Buchner, and E. Proksch, “Windeldermatitis [Diaper dermatitis],”
Hautarzt, vol. 62, no. 9, pp. 699–709, 2011.
[2] R. Philipp, A. Hughes, and J. Golding, “Getting to the bottom of nappy rash. ALSPAC
Survey Team. Avon Longitudinal Study of Pregnancy and Childhood,” Br J Gen Pract,
vol. 47, no. 421, pp. 493–497, 1997.
[3] N. Martins, I. C. F. R. Ferreira, L. Barros, S. Silva, and M. Henriques, “Candidiasis:
predisposing factors, prevention, diagnosis and alternative treatment,” Myco-
pathologia, vol. 177, no. 5-6, pp. 223–240, 2014.
[4] Y. Tüzün, R. Wolf, S. Bağlam, and B. Engin, “Diaper (napkin) dermatitis: A fold
(intertriginous) dermatosis,” Clinics in Dermatology, vol. 33, no. 4, pp. 477–482, 2015.
[5] S. Adalat, D. Wall, and H. Goodyear, “Diaper dermatitis-frequency and contributory
factors in hospital attending children,” Pediatric Dermatology, vol. 24, no. 5, pp. 483–
488, 2007.
[6] J. L. Verbov, “Skin problems in children,” Practitioner, vol. 217, no. 1299, pp. 403–415,
1976.
[7] R. Wolf, D. Wolf, B. Tüzün, and Y. Tüzün, “Diaper dermatitis,” Clinics in Dermatology,
vol. 18, no. 6, pp. 657–660, 2000.
[8] C. Klunk, E. Domingues, and K. Wiss, “An update on diaper dermatitis,” Clinics in
Dermatology, vol. 32, no. 4, pp. 477–487, 2014.
[9] A. Bonifaz, R. Rojas, A. Tirado-Sánchez et al., “Superficial Mycoses Associated with
Diaper Dermatitis,” Mycopathologia, vol. 181, no. 9-10, pp. 671–679, 2016.
[10] M. O. Visscher, R. Chatterjee, K. A. Munson, W. L. Pickens, and S. B. Hoath, “Changes
in diapered and nondiapered infant skin over the first month of life,” Pediatric
Dermatology, vol. 17, no. 1, pp. 45–51, 2000.
[11] D. J. Atherton, “A review of the pathophysiology prevention and treatment of irritant
diaper dermatitis,” Current Medical Research and Opinion, vol. 20, no. 5, pp. 645–649,
2004.
[12] P. E. Kellen, “Diaper dermatitis: Differential diagnosis and management,” Canadian
Family Physician, vol. 36, pp. 1569–1572, 1990.
[13] S. Friedlander, L. Eichenfield, J. Leyden, J. Shu, and M. Spellman, Diaper dermatitis:
appropriate evaluation and optimal management strategies. Medisys Health
Communications. 2009:1-16.
[14] G. Ferrazzini, R. R. Kaiser, S.-K. Hirsig Cheng et al., “Microbiological aspects of diaper
dermatitis,” Dermatology, vol. 206, no. 2, pp. 136–141, 2003.
[15] M. Candidiasis, “Antifungal agents for common paediatric infections,” Paediatrics &
Child Health, vol. 12, no. 10, pp. 875–878, 2007.
[16] P. Sudbery, N. Gow, and J. Berman, “The distinct morphogenic states of Candida
albicans,” Trends in Microbiology, vol. 12, no. 7, pp. 317–324, 2004.
[17] D. K. Morales, D. A. Hogan, and H. D. Madhani, “Candida albicans Interactions with
Bacteria in the Context of Human Health and Disease,” PLoS Pathogens, vol. 6, no.
4, p. e1000886, 2010.
[18] A. K. Gupta and A. R. Skinner, “Management of diaper dermatitis,” International
Journal of Dermatology, vol. 43, no. 11, pp. 830–834, 2004.
[19] L. F. Montes, R. F. Pittillo, D. Hunt, A. J. Narkates, and H. C. Dillon, “Microbial Flora
of Infant’s Skin: Comparison of Types of Microorganisms Between Normal Skin and
Diaper Dermatitis,” Archives of Dermatology, vol. 103, no. 6, pp. 640–648, 1971.
[20] B. Hube, “ Candida albicans secreted aspartyl proteinases,” Current Topics in Medical
Mycology, vol. 7, no. 1, pp. 55–69, 1996.
[21] J. R. Naglik, S. J. Challacombe, and B. Hube, “Candida albicans secreted aspartyl
proteinases in virulence and pathogenesis,” Microbiology and Molecular Biology
Reviews, vol. 67, no. 3, pp. 400–428, 2003.
[22] A. Rebora and J. J. Leyden, “Napkin (diaper) dermatitis and gastrointestinal carriage
of Candida albicans,” British Journal of Dermatology, vol. 105, no. 5, pp. 551–555, 1981.
[23] M.-E. Bougnoux, D. Diogo, N. François et al., “Multilocus sequence typing reveals
intrafamilial transmission and microevolutions of Candida albicans isolates from the
human digestive tract,” Journal of Clinical Microbiology, vol. 44, no. 5, pp. 1810–1820,
2006.
[24] H. C. Makrides and T. W. MacFarlane, “An investigation of the factors involved in
increased adherence of C. albicans to epithelial cells mediated by E. coli,” Microbios,
vol. 38, no. 153-154, pp. 177–185, 1983.
[25] E. Ghelardi, G. Pichierri, B. Castagna, S. Barnini, A. Tavanti, and M. Campa, “Efficacy
of Chromogenic Candida Agar for isolation and presumptive identification of
pathogenic yeast species,” Clinical Microbiology and Infection, vol. 14, no. 2, pp. 141–
147, 2008.
[26] E. Stefaniuk, A. Baraniak, M. Fortuna, and W. Hryniewicz, “Usefulness of CHRO-
Magar candida medium, biochemical methods - API ID32C and VITEK 2 compact
and Two MALDI-TOF MS systems for candida spp. identification,” Polish Journal of
Microbiology, vol. 65, no. 1, pp. 111–114, 2016.
[27] K. A. Brogden and J. M. Guthmiller, Interactions between Candida species and
bacteria in mixed infections. 2002.
[28] S. Borkowski, “Diaper rash care and management,” Pediatric nursing, vol. 30, no. 6,
pp. 467–470, 2004.
[29] J. Ali Bilal, M. Issa Ahmad, A. A. Al Robaee, A. A. Alzolibani, H. A. Al Shobaili, and
M. S. Al-Khowailed, “Pattern of bacterial colonization of atopic dermatitis in Saudi
children,” Journal of Clinical and Diagnostic Research, vol. 7, no. 9, pp. 1968–1970,
2013.
Published
2021-08-25
Section
Original Articles