Sam was diagnosed with diaper Candida, which is more commonly known as a yeast infection from diaper rash. Diaper rash is characterized by redness and irritation in the diaper area which can cause pain and discomfort for the infant (Montoya, 2008). The diaper rashes on genitals of infants can be caused from the wet diaper and in situations in which the preventative diaper creams did not work. The location of the area, the warmth, and moisture create a prime area for fungi to grow. The rash can worsen even with the use of over-the-counter antibiotic creams such as the one the Ms. Jones was using on Sam. In this case, Sam was prescribed topical Clotrimazole (Lotrimin) to be used TID for 4 days to the diaper area. According to Kyle & Dahl (2004), topical pharmacologic agents such as creams, lotions, or sprays are applied to the skin over the affected area in which they penetrate the stratum corneum to kill the fungi or at least intervening and preventing the fungi from being able to grow or divide. Specifically, -azoles such as Clotrimazole, limit the fungal growth but depend on the turnover of skin shedding to rid the fungus from the skin (Kyle & Dahl, 2004). The mechanism of action of Clotrimazole and fungicidal agents alike, allow penetration of the stratum corneum where further growth is inhibited and the replication.
           In developing a teaching plan for Ms. Jones and Sam, the provider should suggest things such as keeping the diaper area as dry as possible. Although impossible to keep completely dry at all times while the rash is healing, Ms. Jones should be instructed to change the diapers frequently. In addition to changing the diapers often, Ms. Jones can also try leaving Sam without a diaper for a few minutes throughout the day if that is a possibility. In doing so, the skin can breathe and stay dry. When changing Sams diaper, Ms. Jones should be instructed to pat the area clean and allow to dry prior to placing antibiotic or clean diaper. The skin should not be rubbed as it can cause open sores or hurt the baby. Ms. Jones should also be informed of using the antibiotic as prescribed in order to preventing worsening of the rash, and she should be aware to notify the provider if the infant begins to have a fever or rash worsens. Since diaper rash is more common in babies that have begun to east solid foods, it would be a good suggestion to stay away from acidic foods that might make the urine more acidic. Completely stopping solids and only giving breast milk or formula is also a great option.
              It is difficult to treat diaper Candida as the moisture and location make it difficult to keep dry. Since it is also painful it can cause stress to parents as the baby can be uncomfortable and become fussy. Parents such as Ms. Jones should be informed that it can take some time for the rash to completely go away even with the use of the anti-fungal creams.
Reference
Kyle, A. a., & Dahl, M. V. (2004). Topical Therapy for Fungal Infections. American Journal of Clinical Dermatology, 5(6), 443-451. https://doi.org/10.2165/00128071-200405060-00009 (Links to an external site.)
Montoya, C. (2008). Diaper Dermatitis: Smart and Effective Management. American Journal for Nurse Practitioners, 12(9), 11-20.