Candida is a yeast that commonly superinfects inflamed, warm, moist skin The typical clinical appearance is erythema in skin folds with pustules and peeling in the periphery (satellite pustules) ( Fig 66.14 ) Candidal infection of the oropharynx (“thrush”) presents with white papules and plaques that cannot be easily wiped off Feeding may be painful Thrush is common in young infants or after use of systemic antibiotics or steroids In older children with no steroid or antibiotic exposure, thrush may be a marker of immunosuppression Diagnosis is usually clinical but the white discharge can be cultured to prove the diagnosis Therapy is with topical nystatin or clotrimazole troches (in older children) or oral fluconazole if severe Neonatal candida infections can be mild or severe depending on the age and weight of the child and the mode of infection If there is premature rupture of membranes and an ascending candida infection, the child is surrounded by candida in the amniotic fluid Infants may be born with broad redness that looks like a sunburn and then often develops superimposed pustules and then peels within a few days This type of candida infection is severe and can be life threatening, especially in children under 1,000 g All children with congenital candidiasis should be evaluated for clinical signs of systemic infection and treated under the guidance of an infectious disease specialist Those under 1,000 g should be treated systemically and evaluated for more widespread infection