Published date: Sep 06 2017

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 12 (2017), Issue No. 3

Pages: 174-186

DOI: 10.18502/sjms.v12i3.934

Amani Hussein Karsaniamanikarsani@qumed.edu.sa

Abdullateef A. Alzolibani

Yasser Farouq

Khalid Zedan

Mohammed Mohsen Alotaibi

Ghada Bin Saif

Ibrahim H. Babikir

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.

Keywords: Candida albicans; Napkin dermatitis; Diaper dermatitis; Vitek 2 compact system; Qassim.

[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,” Mycopathologia, 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 CHROMagar 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.