A 15-month-old toddler has bright red erythema of the perianal and napkin area with sharply marginated borders and scattered small pustules just beyond the edge of the main rash. The creases are involved, unlike the sparing usually seen with simple irritant dermatitis. What is the most appropriate initial therapy?

• A Topical nystatin cream applied after each diaper change ✓
• B Oral fluconazole for 7 days
• C Topical hydrocortisone alone twice daily
• D Frequent exposure of the area to air and barrier petroleum jelly alone

Explanation

Satellite pustules beyond the advancing border plus involvement of the skin folds indicate secondary candidiasis superimposed on diaper dermatitis. Topical nystatin (or clotrimazole) is the standard first-line agent and is sufficient in an immunocompetent toddler; oral fluconazole is reserved for extensive or refractory disease. Barrier measures alone will not clear established Candida, and steroids used without an antifungal can worsen the infection.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.