Systemic candidiasis: cutaneous manifestations in low birth weight infants

The cutaneous manifestations of 18 infants treated for systemic candidiasis during a 3 3/4-year period were examined. Eight infants, with a mean birth weight of 712 +/- 161 g, had a diffuse burn-like dermatitis, usually within the first three days of life. Candida pseudohyphae were identifiable on skin scrapings. A history of a maternal cerclage or intrauterine device complicated by chorioamnionitis was common. A delay in diagnosis or therapy resulted in mortality, whereas promptly treated infants survived. Nine additional infants had monilial diaper rashes, which spread to the trunk and extremities in four infants. These infants were older at the onset of the dermatitis, and all survived the systemic infection. Systemic candidiasis without any cutaneous involvement developed in only one infant. Candidiasis should be more frequently considered, and prompt systemic therapy should be instituted when cutaneous candidiasis occurs within the first few days of life in infants who weigh less than 1,500 g.