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Skin nontumor

Infectious disorders

Candida

Author: Ha Kirsten Do

Last author update: 1 July 2011

Last staff update: 7 March 2024

Copyright: 2002-2024, PathologyOutlines.com, Inc.

PubMed Search: Fungi - Candida [title]

Table of Contents

Cite this page: Do HK. Candida. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skinnontumorfungicandida.html. Accessed December 22nd, 2024.

Definition / general

Candida albicans is a part of the normal human skin flora
Cutaneous candidiasis is a superficial infection of skin and mucous membranes and the most common Candidal infection

Terminology

Cutaneous candidal infections include:
- Oral candidasis
- Candidal intertrigo (affects body folds): acute (wet and red), subacute (red +/- maceration), or chronic (red and dry)
- Candidal diaper dermatitis
- Candidal vulvovaginitis
- Candidal balanitis
- Candidal nail infection: chronic paronychia, onycholysis

Epidemiology

In U.S., Candida species are a common cause of intertrigo in both elderly and diabetic patients
Candida species colonize the oropharynx in 30 - 55% of healthy young adults, and are commonly found in normal fecal flora
3 out of 4 women will have at least one Candidal vulvoganitis during their lifetime
For patients with systemic infections, Candida species is now the 4th most common pathogen from blood cultures
More than 90% of HIV population who are not on highly active antiretroviral therapy will develop oropharyngeal candidiasis and 10% develop esophageal candidasis
Internationally, Candida species have replaced Cryptococcus species as the most common fungal pathogens affecting immunocompromised hosts

Clinical features

Predisposing factors for opportunistic infection with C. albicans include:
- Infancy or elderly
- Warm climate
- Occlusive clothing, poor personal hygiene, dental plates
- Immune deficiencies (low levels of immunoglobulins, HIV, cancer)
- Broad spectrum antibiotic treatment
- High dose estrogen contraceptive pills or pregnancy
- Chemotherapy or immunosuppressive medications such as systemic steroids
- Locally applied topical steroids
- Diabetes mellitus, obesity, Cushing syndrome and other endocrine conditions
- Iron deficiency
- Malnutrition
- Underlying dermatological disease like psoriasis, lichen planus, irritant contact dermatitis
- Mortality is relative low for cutaneous Candidal infection in healthy patients; however, the mortality rate is up to 30 - 40% in disseminated / systemic candidasis in immunosuppressed patients
The characteristic skin manifestation is red and white patches on mucosal surfaces (leukoplakia)
In skin folds, it results in moist fissuring with a superfical erythema patch with satellite papulopustules

Diagnosis

KOH preparation and skin scraping is the easiest and most cost effective method for diagnosing cutaneous candidiasis
Culture from intact pustule or skin biopsy tissue can support the diagnosis

Case reports

Extensive cutaneous candidiasis revealing cutaneous T cell lymphoma: 2 cases (Ann Dermatol Venereol 2006;133:566)

Treatment

Note: please confirm accuracy of medications below before use
Oral candidiasis:
- Nystatin oral suspension x 10 - 14 days or until 48 - 72 hours after resolution of symptoms
- Dosage for preterm infants is 0.5 mL (50,000 U) to each side of mouth 4 times / day; for infants is 1 mL (100,000 U) to each side of the mouth 4 times/d; for adults 4 - 6 mL (100,000 U) PO swish and swallow qid
Candidal intertrigo:
- Keep the skin dry, with the addition of topical nystatin powder, clotrimazole, or miconazole twice daily, often in conjunction with a midpotency corticosteroid
- Extensive infection may require the addition of fluconazole (100 mg PO qd for 1 - 2 wk) or itraconazole (100 mg PO qd for 1 - 2 wk)
Acute intertrigo:
- Can use Domeboro solution, Castellani paint or vinegar/water (1 tbsp vinegar per quart room-temperature water) to apply twice per day for 5 - 10 minutes for 3 - 5 days as needed
- Dry the area with a hair dryer (low heat)
- Can also apply triamcinolone-nystatin cream twice daily
Subacute intertrigo:
- Can use benzoyl peroxide wash to cleanse the area instead of application of vinegar or Castellani paint
- A topical anticandidal cream of choice is applied twice per day, with or without a mild hydrocortisone cream
Chronic intertrigo:
- Can use zinc-talc shake lotion once or twice daily, and the hydrocortisone cream / antifungal mixture may be applied at night
- Local hyperhidrosis may be treated with antiperspirants (ie, Arid Extra Dry Unscented, Dry Idea) on a long-term basis
Candidal diaper dermatitis:
- Goal is to minimize the time the diaper area is exposed to hot and humid conditions; air drying, frequent diaper changes and generous use of baby powders and zinc oxide paste are adequate preventive measures
- Apply topical nystatin, amphotericin B, miconazole or clotrimazole to affected areas twice daily x 7 days
Candidal vulvovaginitis:
- Topical antifungal agents (Micatin, Monistat-Derm), or clotrimazole (Lotrimin, Mycelex) creams twice daily x 7 days or intravaginal appliator QHS x 7 days are curative
- One-time oral therapy with fluconazole (150 mg) or itraconazole (600 mg) is effective and may be a more attractive alternative to some patients, but it is more costly
Candidal balanitis:
- Topical therapy is effective in most patients
- Evaluate asymptomatic sexual partners and treat them if they are infected to prevent recurrence
- For persistent lesions beyond the genitalia, consider the possibility of underlying diabetes or other diseases
Candidal paronychia:
- Topical treatment is usually not effective but should be tried for chronic candidal paronychia
- Drying solutions or antifungal solutions are used
- Oral therapy with either itraconazole (pulse dosing with 200 mg bid for 1 wk of each of 3 consecutive months) or terbinafine (250 mg qd for 3 months) is recommended