Yeast infection gone way too far!!!

[Antikigirl]

I work in an assisted living facility where caregivers do all direct care and meds...there is only one nurse per shift on the floor of 160 residents. So normally when I find a skin issue beyond what the caregivers or that one nurse can do, we call in home health to eval and get a wound care specilist!

Our facility does WONDERS with skin issues! No decubes or long term wounds in our place for sure...we really push and educate our caregivers well! I am so proud of our staff for keeping skin issues to almost 0!~

Alas...we had this one lady who started to get a blotchy red irregular rash on her groinal folds and breasts. Large breasted and has larger abdomen (so lots of deep folds). She was very active and kept these areas dry, but lately she has taken a decline and won't get out of bed.

Well, she declined so rapidly that I sent her to the ED this weekend. They had NO dx for her sudden weakness, but did culture the rash that had grown tremendously, and yeast was found to be the culprit!

Okay so they order 5 days of oral antifungal (now over), and nystatin powder QID for a week. The week is about over and it is now not only shiney, draining severly, uncomfortable, splitting skin, obvious open blister patches, and very very angry...but spread even further over her breasts (the groinal folds are doing well).

We can't seem to get the doctors interest at all! Calls, faxes the works and nothing! I found her today just looking horrid, and she had washcloths under her breasts to keep things dry, but I felt that detergents or just the coorificeness of the material was irritating the area (I don't subscribe to terry cloth for this!). We got her hankerchief thin cotton pads to put there instead, and were able to do a make shift taping to raise her breasts so that they may be exposed to some air bra totally out of the question, folds about 3 inches deep!) Still trying to get a hold of her MD and illicit some sort of action!!!!

Any other words of advise? I mean this is the WORST I have ever seen in my 5 years of being a nurse...and it just is so miserable for her!

Thanks in advance! Really greatly appreciated!

(and yes, the caregivers are overseen by a nurse in this case and the nystatin is cleaned gently (very gently but well) so that their is no balling of the powder...and pat dry with a pad very gently...I mean it really hurts!).

[savannahblues]

As a DON yeast infections among the larger ladies and men, I have seen many residents with yeast in the skin folds.

Never use cornstarch as the sugars in the cornstarch are a feast for yeast. It is better to go with a talc powder that is medicated. Keeping the areas dry is so very important.

We usually called the wound care center if it looked as though it was getting out of hand.

Lucinda in NC:nurse:

[Fyllis LPN]

I just found this site and, unfortunately, the original post here is 5 years old. However, I am sure there are nurses out there who are still finding themselves confronted with treating (and further preventing) abdominal and other body body fold excoriation.

Let me start by saying, I have been a LTC nurse for 19 years. In addition to that, I am obese. So, not only have I found this among my patients, I personally experience it myself. Let me advise you to what works for me and what doesn't.

To begin, let me tell you that the excoriated area is very painful to touch. When possible, it is best to cleanse the area while the patient is in the shower. Rinse the area with tepid water. If the water is too warm, the heat will increase the pain. GENTLY wipe the area with a smooth material, such as a pillow case as opposed to rough terrycloth, then continue to rinse.

PAT the cleansed area gently (NEVER wipe or rub), then place a clean, dry pillowcase- like material in the fold until the patient is returned to bed.

Remove the material carefully - there is the possibility it might stick to the raw flesh. If so, slightly dampen the cloth with saline so it comes away easily, and PAT dry afterward.

Now you can blow the area completely dry with a hair dryer. Be SURE you use the 'cool' button and not apply warm or hot air. (If your facility doesn't have a dryer with a 'cool' function, ask them to purchase one, or bring your own until one is supplied.

Over the years, I have tried a plethora of treatments. Powders alone, such as Nystatin and Gold Bond, sound logical, but I found the powders absorb the moisture and clump into wet globs which caused an increase in the yeast infection and odor. Doctors seem to order this as a treatment of choice, however.

After much trial and error, I found that the OTC antifungal cream Clortrimazole 1% works the best on an active inflammation.

After the area is clean and dried, apply a thin coat over the entire area twice a day. In most cases, I found my excoriation to be cleard within 24/48 hrs.

Once the area has been cleared of the infection and the skin has healed, I also apply an anti-perspirant to the area. Your armpits are not the only places you sweat! This needs to be cleansed off and re-applied daily just as you would under your arms.

On exceptionally hot days throught the summer, opr when the heat is turned up during the winter, keep a clean, smooth cotton material in the fold to absorb any additional moisture, and to prevent skin-to-skin friction.

I will also suggest that you consult with your Dietician and modify their diet. Carbs, sugars, and other foods with high yeast content like breads and pastas will contribute to repeatative outbreaks.

Yeast infections in body folds is an ongoing occurance; especially for the obese. The key is to know your patients and prevent skin breakdown before it happens.

I hope I have given some insight on this topic.

Fyllis

[VeronicaWileyRN]

I know some of you think that Fyllis is crazy for using deodorant in fold areas, but it works. I am over weight and have to battle fungal infections at times and I find that Goldbond foot lotion and then powder works.

[VeronicaWileyRN]

Why does Gold bond put someone at risk for cervical cancer? I am just curious.

[Fyllis LPN]

in response to: veronicawileyrn - "why does gold bond put someone at risk for cervical cancer? i am just curious".

i found the following information online. hope it helps.

from the cancer prevention coalition:

"talc is a mineral produced by the mining of talc rocks and then processed by crushing, drying and milling. processing eliminates a number of trace minerals from the talc, but does not separate minute fibers which are very similar to asbestos.

talc is found in a wide variety of consumer products ranging from home and garden pesticides to antacids. however, the products most widely used and that pose the most serious health risks are body powders. talc is the main ingredient in baby powder, medicated powders, perfumed powders and designer perfumed body powders. because talc is resistant to moisture, it is also used by the pharmaceutical industry to manufacture medications and is a listed ingredient of some antacids. talc is the principal ingredient used in smaller quantities in deodorants, chalk, crayons, textiles, soap, insulating materials, paints, asphalt filler, paper, and in food processing.

talc is closely related to the potent carcinogen asbestos. talc particles have been shown to cause tumors in the ovaries and lungs of cancer victims. for the last 30 years, scientists have closely scrutinized talc particles and found dangerous similarities to asbestos. responding to this evidence in 1973, the fda drafted a resolution that would limit the amount of asbestos-like fibers in cosmetic grade talc. however, no ruling has ever been made and today, cosmetic grade talc remains non-regulated by the federal government. this inaction ignores a 1993 national toxicology program report which found that cosmetic grade talc, without any asbestos-like fibers, caused tumors in animal subjects. clearly with or without asbestos-like fibers, cosmetic grade talcum powder is a carcinogen.

talc is toxic. talc particles cause tumors in human ovaries and lungs. numerous studies have shown a strong link between frequent use of talc in the female genital area and ovarian cancer. talc particles are able to move through the reproductive system and become imbedded in the lining of the ovary. researchers have found talc particles in ovarian tumors and have found that women with ovarian cancer have used talcom powder in their genital area more frequently than healthy women.

talc poses a health risk when exposed to the lungs. talc miners have shown higher rates of lung cancer and other respiratory illnesses from exposure to industrial grade talc, which contains dangerous silica and asbestos. the common household hazard posed by talc is inhalation of baby powder by infants. since the early 1980's, records show that several thousand infants each year have died or become seriously ill following accidental inhalation of baby powder.

talc is used on babies because it absorbs unpleasant moisture. clearly, dusting with talcum powder endangers an infant's lungs at the prospect of inhalation. exposing children to this carcinogen is unnecessary and dangerous.

actions you can take:

1. do not buy or use products containing talc. it is especially important that women not apply talc to underwear or sanitary pads.

2. contact your pediatrician and/or local hospital and find out if they have a policy regarding talc use and infants.

3. write to the fda and express your concern that a proven carcinogen has remained unregulated while millions of people are unknowingly exposed.

contact:

cancer prevention coalition

c/o university of illinois at chicago

school of public health, m/c 922

2121 west taylor street

chicago, il 60612

tel: [phone]

e-mail: [email protected] "

fyllis lpn