When a simple diaper rash turns severe

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September 13, 2004 E-mail story Print

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IN THE LAB

When a simple diaper rash turns severe

New cream appears safer for treating the yeast-like fungus that can

raise red marks, sores or blisters on an infant's skin.

By Marsa, Special to The Times

Diaper rashes are one of the banes of infancy. Most are mild, caused

simply by irritation of the skin, and disappear within a few days.

But rashes complicated by a fungal infection can persist for weeks,

making babies fussy and uncomfortable.

The combination of drugs used to treat these severe rashes is not

ideal. One medication has side effects; the other hasn't been tested

on children. However, a new topical cream, called Zimycan, appears to

safely treat both the cause and the symptoms in infants.

" This cream will be nice to have because these infections are so

common and the kids are miserable, which makes the parents miserable

too, " says Dr. Dennis B. Woo, chairman of the department of

pediatrics at Santa -UCLA Medical Center.

Each year, about 400,000 babies suffer from severe diaper rash caused

by Candida, a yeast-like fungus that thrives in the warm and moist

environment of the diaper. Typically, yeast rashes are a bright,

beefy red with sharp, raised borders and white scales on the surface.

The main patches are often surrounded by smaller patches and painful

pus-filled sores or blisters. In severe cases, the rash can cover the

entire diaper area.

Infants get yeast infections when their diapers chafe and break the

surface of the skin. When this protective barrier is breached, it's

easier for microorganisms such as the yeast fungus to invade the

skin, Woo says. Babies taking antibiotics for ear infections or other

illnesses are prone to these severe rashes because penicillin kills

off bacteria that fight yeast infections.

" And it's not just babies, " says Dr. J. Leyden, a dermatologist

at the University of Pennsylvania School of Medicine in Philadelphia

who helped develop Zimycan. " Even the very elderly, who are

incontinent and unable to care for themselves, are getting these type

of diaper rashes. "

No drugs have been approved for diaper rash complicated by a yeast

infection, but pediatricians often prescribe antifungal agents

designed for adults, plus topical steroids to reduce the

inflammation. However, prolonged use of steroids can thin a baby's

sensitive skin, leaving stretch marks, and may exacerbate bacterial

and fungal infections, says Dr. K. Spraker, a pediatric

dermatologist at Emory University in Atlanta who assisted in a recent

study of Zimycan.

" With the adult antifungal preparations, " she adds, " we don't know if

they're really safe for babies, or if they provide optimal relief

because they have never been tested on infants. "

Zimycan, in contrast, contains zinc oxide and a weakened version of

miconazole, a fungus-fighting medication used for adults. " Zinc oxide

by itself doesn't have much effect on the yeast, " Leyden says. " But

we found that zinc oxide enhanced the effects of the miconazole, so

the two compounds in combination were more potent than when they were

used individually. "

A recent test comparing Zimycan with a zinc oxide ointment, which is

the standard of care for diaper dermatitis, was encouraging. In the

study, 236 children younger than 3 who had a Candida yeast infection

in the diaper area were treated for seven days with either Zimycan or

the zinc ointment. At the end of treatment, the Zimycan group

experienced a 72% reduction in signs and symptoms of the disease,

versus 25% with the ointment. " These results were exciting because we

could prove the cream really works, " Spraker says.

*

(BEGIN TEXT OF INFOBOX)

Keeping babies rash-free

More than half of infants younger than 15 months develop diaper rash

at least once every two months because their skin is so sensitive.

Excessive moisture is the primary culprit. When the skin is wet, it

rubs against other skin or the diaper, causing friction and redness,

especially in the skin folds of the groin and upper thighs. Enzymes

and other substances in the stool can also irritate the skin. Babies

may also be allergic to the diaper material, soap or laundry

detergent.

Today's super-absorbent disposable diapers are better at keeping the

skin dry, but experts say diapers should still be changed six or

seven times a day, and immediately after stooling. If an allergy is

the cause, then changing the diaper, soap or laundry detergent brand

usually solves the problem. " If the rash persists more than three

days or seems to get worse, " says Dr. K. Spraker, " then it's

time to see your pediatrician. "