A 9-month-old in diapers has confluent erythema and satellite pustules extending into the inguinal folds, with involvement of the scrotum. The rash worsened after a course of oral amoxicillin. Best initial topical therapy is:

• A Topical combination betamethasone-clotrimazole cream
• B Topical nystatin cream ✓
• C Barrier zinc oxide paste alone
• D Topical mupirocin

Explanation

Satellite pustules, involvement of the creases and onset after antibiotics point to candidal diaper dermatitis, treated with topical nystatin or an imidazole such as clotrimazole. Fixed-combination steroid-antifungal preparations should be avoided in the diaper area because potent steroids cause skin atrophy and striae there. Zinc oxide barrier paste addresses irritant contact dermatitis alone, and mupirocin targets bacterial impetiginization, neither of which explains satellite lesions.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.