treatment for inflammed foreskin?

[caedmyn]

I don't know if this is a good place to post this or not. My DS' foreskin is red and swollen. He is circumcised. I have been putting diaper rash cream on it for a couple of days but it does not seem to be getting any better. Any suggestions on how to treat it? He is pretty crabby today but I don't know if it's related or not as he's teething off and on (been working on these darn teeth for 3+ months, they just won't pop throuh) and he's a crabby baby normally anyway.

[eepster]

Is it the glans, remnant foreskin, shaft skin or scar line where the issue is?

It might be yeast, but with out more details it's hard to eliminate other possibilities like the beginnings of meatal stenosis, or adhessions, etc.

I'd start with lots of diaper free time to air everything out, and strip the diapers if they are cloth. If your using sposies, some brands have scents and stuff so you might try switching.

Does the diaper cream your using have zinc oxide and other healing stuff in it, or is it just a barrier cream? I highly recommend Burt's Bees diaper cream, it has all kinds of healing stuff in it. We still put it on DS's occasionally itchy bottom even though he's been out of diapers for over a year.

[MommytoB]

How old is he ? Is his remaining foreskin getting pulled back at bath and every diaper change ? Is he a loose circ where the leftover foreskin still covers the glans ?

[caedmyn]

He is 12 months. I do use cloth and just stripped the diapers a day or two ago (with vinegar). I primarily use wool covers so they do breathe, and a lot of his diapers lately are barely wet as we're part-time EC'ing and I think he is hold his pees sometimes. He had a loose circumcision and does a large adhesion that goes at least half way around, but that's been there for several months. I leave his penis alone other than wiping poop off during diaper changes. And it is the remnant foreskin that is red and swollen. The diaper cream is Burt's Bees.

[FaithfulOne]

I might try and put some antifungal cream (monostat, canesten etc)
Otherwise it may be best to check with your Dr.
My ds's are intact so I'm not super certain on treating remnant skin, my suggestion is soley based on what I'd do to a whole penis (thinking any superificial chaffing would be similar)

[MCatLvrMom2A&X]

first try 7 day monistat yeast cream. If you dont see improvement with that then try otc bacatracin. One of those should do the trick if not then you should take him to the Dr. for a culture to see what the problem is.

[eepster]

With the additional details it sounds like it's probably yeast. I'd go with Faithfulone's treatment suggestion, and see if that clears it up.

[caedmyn]

So I've been doing the Monistat since Sunday. It looks a little better and doesn't seem sore anymore, but on the whole it's not a huge improvement. Should I keep using the Monistat for the full 7 days, or switch to the Bacitrin, or just use both for a couple of days and see what happens?

[tutucrazy]

Yeast infection is pretty hard to get out of cloth diapers. For your diapers you need to strip them well with vinegar and hang them in direct sunlight to kill the yeast. The sunlight is essential. I would keep him in sposies until yeast is gone. Also, in my experience the OCT yeast creams don't work. I'd go with diflucan oral suspension.

You have to be careful b/c bacitracin is the opposite of what you want to give him if this is in fact a yeast infection. Bacitracin is an anti-biotic ointment that will kill the good bacteria which can create more yeast.

If you do EC and have not had him on any antibiotics, I'm skeptical that this is even yeast in the first place. It could be some inflammation from the adhesions releasing in certain areas. The foreskin is very vascular and will react to trauma by swelling and redness. If you take him to the doctor, make sure they don't pull back his foreskin. It should be left alone. They can culture it to see if there is yeast present simply by swabbing the outside.

[caedmyn]

We EC very part-time...he is in diapers full time and I only take him potty at diaper changes, if he's dry then or if I think he has to go (so 3-5 times a day). Neither of us has had any antibiotics. I put him in sposies for a full day (and have been using them at night for several days) but didn't see any improvement. I don't think direct sunlight is possible for the diapers right now, unless direct sunlight through a window would work (and that would take days to rotate through all my diapers)...it is super windy here in the winter and we don't have a clothes line so I can't put diapers outside. I did wash them with a little tea tree oil in the wash.

If it's inflammation from adhesions releasing, would the entire remnant foreskin (the top 1/4" or so anyway) be red and swollen? His adhesion only circled around about half of his penis, and it is still visible though only if you know what to look for (it's just a little more swollen looking than the rest of the foreskin). And this has been going on for nearly two weeks now too. Would it be obvious if adhensions were releasing? As far as I can tell the foreskin is pretty well sealed to the penis, if that makes sense.

I'll probably end up taking him to the doctor...I just hate to pay $100+ to go. If he does need an oral yeast medication I'd probably request nystatin...diflucan is supposed to be really hard on the liver and I'm not keen on giving an infant something that's very hard on the liver.

[tutucrazy]

Unfortunately nystatin as a topical treatment is pretty darn ineffective in my experience. But who knows it might work for you. As an oral treatment nystatin would not treat the skin b/c it works differently than diflucan. Nystatin kills the fungus on contact so what your son takes in orally will never come in contact with his penis skin. Diflucan works differently in that it prevents the growth of fungus and is absorbed through the system. I tried nystatin and it didn't work for my son's butt yeast. Oral diflucan was the only thing that worked for us, my son had internal yeast and yeast around his anus. For his anus I actually made my own treatment. I dropped 5 drops of Citricidal Grapefruit seed extract into a 2 oz of water. (Stir well). You need the name brand one and make sure it says professional strength. This one: http://www.crohns.net/page/C/PROD/CVR0621 At every diaper changed I swabbed his anus with a cotton ball of the solution. I never put it on my son's foreskin so I have no idea if it is safe for the foreskin, but I imagine it would be okay. If you do use it make sure it is very well-diluted.

If it were me:

I'd first stop using anything for a couple days and keep him in sposies to see if it gets better. Be extra careful not to use soap on his genitals and make sure he isn't sitting in soapy bathwater. Also avoid using wipes on his penis unless you need to. You can get some acidophilus (probiotics) at the health food store and give it to him orally and put some on him topically. Then, if you don't see any improvement get the culture and while you are waiting for the results try the topical nystatin. If the culture comes back positive for yeast then you can decide if it might be better to knock it out with the Diflucan.

As for the diapers, you really need direct sunlight. I think it would be fine through a window. I know that vinegar rinse alone probably won't get out the yeast and you could risk reinfecting. You might be able to treat the diapers with the Citricidal but I am not sure of the ratio you would need. Keep him in sposies until you find out fore sure what this is.

Does the skin look peely, dry or bumpy?

[caedmyn]

It does not look peely, dry, or bumpy. Just a little red and inflammed. I put some yogurt with live cultured on it today so we'll see if that does anything! We're away from home for a couple more days so I don't have access to all my first-aid stuff, but I can try the GSE (pretty sure what I have is citricidel) when we get home, and sunning and all that stuff. From what I read before when I thought my older child had yeast issues tea tree oil is supposed to be really good at killing yeast in diapers.

I am still hoping to avoid taking him to a doctor unless I have to since it's pricey and we don't have insurance, so unless I can't clear it up myself nystatin or diflucan aren't options anyway. It does look quite a bit better so I must be doing something right.

I only use wet washcloths to wipe him off and he doesn't get baths very often (he is super wild in the bathtub and I am always afraid he will get hurt). I don't wipe him off after every wet diaper though...should I?

[eepster]

I didn't wipe at every diaper change either. I always viewed it as over drying and possibly throwing off the flora/ph balance etc.

I missed that you were out of town in you earlier posts. I've noticed that these kinds of issues often come up when travelling. I suspect that the part of the five point harness on the carseat that goes up between the legs chafes and causes swelling and redness in the very sensitive and vascular foreskin.

[Fi.]

Plain yogurt. Topically. No joke. Slather it on there, let it sit a bit, wipe it off.

TMI: When I have YIs I insert 3 applicators full just like Monistat. Works in half the time.

Pro-biotics help too.

[tutucrazy]

I'm glad you are trying this method first. You can also buy acidophilus at the health food store and put it on.

Just be sure to dilute the GSE well try 5 drops per 2oz water first. If you see little improvement after a few days you can up it to 10 drops per 2oz. You will want to apply it with a cotton ball 3 times per day. GSE is extremely good stuff and has both anti-fungal and anti-microbial properties. It should help restore the natural balance. When I used it around my son's anus the yeast was started to disappear after about 2-3 days. I kept using it for a full week just to be sure everything was gone. It worked better than nystatin and any other anti-yeast cream.

I hope things clear up for your little one. I'm sorry you have to deal with this while on the road. Isn't that how things always work out!?!