Cutaneous candidiasis.

Newborn infants commonly develop erythematous papules and scaling associated with erythema toxicum and normal neonatal desquamation. Cutaneous candidiasis can easily be overlooked. This issue of Pediatric Dermatology contains two reports of cutaneous candidiasis. In one infant the diagnosis was made soon after birth, whereas a week delay occurred in the diagnosis of the second infant. These case reports document cutaneous lesions seen in congenital candidiasis as well as review the features of acquired candidiasis. All infants with erythematous papules or pustules present at birth should have a complete cutaneous evaluation to identify the specific cause of the skin lesions, lf the lesions are extensive and not characteristic of classic erythema toxicum, potassium hydroxide (KOH) examination of lesions should be a routine part of the evaluation. If the KOH is positive, confirmation of the diagnosis with a cutaneous fungal culture is also beneficial. For individuals unsure of their ability to interpret the KOH, the fungal culture can be done as a substitute, but the diagnosis will be delayed until the results are known. None of these tests will be done if the clinician does not have adequate suspicion of the diagnosis of cutaneous congenital candidiasis. The frequency of vaginal candidiasis at the time of delivery is 20% to 25% (I). The infrequency of the diagnosis of cutaneous congenital candidiasis or neonatal candidiasis supports the effectiveness of the intact epidermis and mucous membranes to resist Candida albicans invasion. Even without topical therapy, children with cutaneous congenital candidiasis may resolve their dermatitis. Because the risk of topical therapy appears low and the benefit in decreasing dermatitis may be high, we should promote KOH examinations of the skin of infants with scale and/or pustules at birth. Greater attention to this problem may help us to increase the frequency of recognition and decrease the associated morbidity and possible mortality.