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Suggest Treatment For Foamy Loose Stool And Skin Rashes In An Infant

Posted on Mon, 24 Aug 2015

Question: Hi,
My 14 month old has been passing foamy stool for the last few days. However, since today morning, she has been passing liquid stool (mucus and greenish). It looks like an amoebic dysentery. She has passed stool at least 8 times since morning.
We have consulted Doctor. I am attaching the prescription for your reference.
She has developed skin rashes around anal opening due to friction and wetness from motions and wiping. I am applying boroline over there. Can we apply creams like Candid there? Or should oil be applied? This must be painful for her and adding to her discomfort.
Please suggest some remedy for this. Also, if you can let us know if we should immediately start her with antibiotics or wait for 2 days.
Thanks.

Answered by Dr. Pradeep Kumar Jain (5 hours later)

Brief Answer:
I won't suggest to give antibiotic now

Detailed Answer:
Hello

Thanks for the query

I have gone through the prescription and image.The most common cause of loose stool(unless mixed with blood) in this age is some viral infection and antibiotic won't help much in this condition.It may take 7-8 days for the stool to get back to its normal pattern.The green color of stool is not due to infection but due to increased intestinal motility.Due to increased motility the pigment responsible for yellowish color of stool could not be formed well.
The main aim is to maintain proper hydration by giving plenty of fluids(ORS).
Avoid milk(if not predominantly milk fed),fruit juices in diet as this may aggravate the loose stool(because of lactose and sorbitol).The diet shoudl be easily digestible like Curd(contains probiotic),rice and khichdi.
In the prescription doctor has advised enterogermina(a probiotic),colicaid(for colic),ondem(for vomiting) and Ziprax(an antibiotic).
Apart of antibiotic you can give all the medication.
I would suggest you to give Zinc syrup 5 ml(20 mg) daily as it helps in early recovery by maintaining the inner layer of intestine.
Rashes are common in perianal region during loose stool.I would suggest you to apply Rashfree/Ezinapi(any cream containing zinc oxide)instead of oil or borolin.After going through the image it doesn't look like candida dermatitis.
Clean your hand properly before applying the cream.Keep the area dry by frequent change of diaper.Don't rub the area for cleaning but XXXXXXX it gently with the help of baby wipes to prevent further injury.
If you notice any poor oral acceptance,irritability,lethargy or decreased urine output(less than 3-4 times a day)consult your doctor immediately.

I hope this helps.
Please do ask if you have any more doubts.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (3 hours later)

Hello,

Thanks for your reply. I am applying Siloderm ointment (containing Dimethicone, Zinc Oxide, Calamine and Cetrimide). Should be suffice? Also, I started with Z & D drops (1 mn daily). Will this be sufficient?

Thanks.

Answered by Dr. Pradeep Kumar Jain (1 hour later)

Brief Answer:
Yes,both siloderm and Z &D will be sufficient

Detailed Answer:
Thanks for writing back

Siloderm is a very good ointment for peri anal dermatitis as it contains zinc oxide (helps in rapid healing of skin),Dimethicone(an anesthetic agent which relieves pain),calamine (soothing agent which decreases burning sensation) and cetrimide (an antibiotic to prevent infection).
Please take proper care of the affected area as I have mentioned earlier.
Z &D contains zinc 20 mg in one ml.So one ml will be sufficient for the baby.

Please take care of hydration and observe for signs of dehydration.

Wishing for your baby's speedy recovery.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (9 hours later)

Hello,

We are taking care of the rash. But it seems to be getting little worse. I am attaching another recent pic for your reference. Should we continue with Siloderm?

Thanks.

Answered by Dr. Pradeep Kumar Jain (41 minutes later)

Brief Answer:
Continue applying siloderm,get a stool test done

Detailed Answer:
I have gone through the image.It seems little worsened in compare to previous pic.
The peri anal dermatitis is due to the acidic consistency of stool and is more common in lactose intolerance (undigested lactose causes irritation to the peri anal area).
Transient lactose intolerance is common during loose stool due to loss of inner layer of intestine which helps in absorption in lactose.
As the inner layer regenerates (zinc helps in regeneration)the lactose intolerance subsides.
I would like to get a stool test done to see presence of any reducing substance which is suggestive of lactose intolerance.
If the stool test shows presence of significant amount of reducing sugar,temporary withdrawal of lactose containing formula will help.In that condition I would like to shift her to lactose free formula for 7-10 days till the time stool pattern gets normal.
Withholding lactose formula will help in early recovery from loose stool and rashes.
There are many creams available with different brand name but the constituents are almost same.So I would like to continue Siloderm only.
Get a stool test done and let me know about the report so that I better able to help you out.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (1 hour later)

Thank you for your reply. However, she has never had outside milk or formula in her life. I tried introducing outside milk couple of times but she developed loose stools. So, I do not even give her anything containing milk like curd.

She is still breastfed (first 6 months exclusive) and now takes solids too.

I had introduced Mosambi and Pomegrenate juice to her since when this foamy stool started. I have stopped that one week back. Can the acidic stool be due to Citric acid from juices?

Answered by Dr. Pradeep Kumar Jain (27 minutes later)

Brief Answer:
Acidic stool not due to citric acid

Detailed Answer:
Thanks for writing back

Adding fruit juice in the diet may be reason of aggravation of loose stool.
Fruit juice contains sorbitol and fructose that does not get absorbed during loose stool due to the same mechanism as I have described earlier in relation to lactose.Due to poor absorption there is high concentration of sorbitol and fructose (carbohydrate) in the intestine and which absorb fluid due to osmosis causing osmotic diarrhea.
Unabsorbed carbohydrate is mainly responsible for acidic stool.
Even breast milk contains lactose and if there is significant amount of reducing substance in stool,we may need to hold breast feed temporarily.
Either you can wait and watch for next 2 days whether the loose stool and rashes are improving or else you can go for stool test right now so that we can take early steps regarding management.

I shall be glad to help you further if you need any.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (13 hours later)

Thanks Doctor, I will get the stool test and stool culture done as soon as possible.
I am bit worried about the rash now ( request you to check the attached pic - file name : skin rash 31-Jul-2015)

I consulted my local physician once again today.. he did not examined the skin though but based on the attached picture he suggested me to apply Vaseline and Proctoguard ointment thrice daily.

Is Proctoguard same as Siloderm and caters to cure similar infection? and do you think this is some kind of topical anti-fungal infection?

i am also facing another issue when my baby is passing stool 7-8 times a day and i need to wipe the affected area which i feel is also aggravating the problem.

I was reading in an article that banana helps to cure acidic stool ! is that true?

Please advice on the ointment... and about adding banana in the diet.

Thanks and Regards
XXXX
Hello Doctor,

Missed one point... We have never given any formula to my baby till date... and she is only on breast feed. this is just FYI,

Thanks and Best Regards

Answered by Dr. Pradeep Kumar Jain (53 minutes later)

Brief Answer:
I won't suggest proctogard

Detailed Answer:
I can understand your concern.
I have seen the image.It does not look like candida dermatitis.
In candida dermatitis there are small white satellite lesions with surrounding redness which is not here.So no need of antifungal cream.
Again proctagard contains sucralfate and oxetacaine.It is mainly used in adult for fissure,hemorrhoids.It does not contains zinc oxide which should be there for healing of peri anal excoriation.So I won't suggest proctagard and vaseline and would like to continue with the siloderm.
I just request you to keep patience as this will improve once the frequency of loose stool decreases.
Avoid rubbing.Use wipes.Change nappies frequently.Keep the area open for sometime to make it dry in air and also to let the skin breath.
Continue zinc,probiotic and ORS.Use mainly rice based feed and avoid wheat/barley also.
Get stool test done and after sending the sample give a trial to hold your breast feed.
If you are holding the breast feed please make the breast empty by manual expression to avoid any engorgement and to promote continuous production of milk.
You can give banana as it helps in recovery from loose stool.
Again I would request you to keep patience as it may take 7-10 days for the stool to get back to its normal pattern.In diarrhea there is loss of inner layer of the intestine and it takes 7-10 days for the inner layer to regenerate and thus also to develop the capacity to hold water in intestine and to digest the food properly.So whatever measures you take it will take its own course.
The main aim is to prevent dehydration by giving plenty of fluids.
I again insist you to provide proper hydration and watch for danger signs like decreased urinary frequency or poor oral acceptance as I have mentioned earlier.

Wishing your baby's speedy recovery.
Feel free to ask any further query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (2 days later)

Hello Sir,

PFA the stool test report.
Also wanted to show the day-5 pics where the skin problem is getting aggravated and I am afraid if this is now a fungal infection?

Do you suggest any medicine like Candid?

Thanks and Regards

Answered by Dr. Pradeep Kumar Jain (58 minutes later)

Brief Answer:
I would suggest you to apply SILODERM MIXI

Detailed Answer:
Thanks for follow up

I have checked the report and images.
Now it appears to be infected with fungus as there are white lesion which were not earlier.
The stool report suggest improper absorption of food material.The reducing sugar test has not been done.

You might think of that from the very initial days you were asking for the possibility of any fungal infection and I refuted.
This is because the lesions were not suggestive during those days.
But now it appears to be get infected with secondary fungal infection.
I would suggest you to apply siloderm mixi ointment.It contains antibiotic ,antifungal and mild steroid and I hope it will fasten the recovery.
I shall be glad to answer if there is any more query.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar