Core Dermatology Diagnoses / CategoriesInfectious

Candidiasis

Author: Deputy Editor: Faculty Reviewer:

Publish date: Posted on
Last updated: January 4, 2024

Keywords #

candida
fungus
yeast
intertrigo

Diagnosis #

Cutaneous candidiasis refers to an infectious skin process caused by the Candida species of fungus, most commonly C. albicans. Candida normally resides in the human gut, but the yeast can cause infection in the skin, mucosa, or blood, especially in immunocompromised individuals. Candidiasis may be the primary infection or arise secondary to other skin conditions and can manifest as genital, perianal, skin, and nail infections.[1] Cutaneous candidiasis comprises about 1% of all outpatient dermatology visits.[2] Cutaneous candida infections are generally diagnosed clinically but may be confirmed with microscopic and culture results.

Key Concepts #
  • Alterations in environmental factors, such as increased humidity or antibiotic use leading to altered microbial flora, often precede a candidal infection. [1] 
  • Cutaneous candidiasis can manifest in many different ways including intertrigo, diaper dermatitis, and angular cheilitis. 
Epidemiology #

Cutaneous candidiasis is the most common dermatologic disease of infancy and is also commonly seen in the elderly population. [3] Known risk factors includes immunosuppression, endocrine disorders, or compromised blood flow. [3]

Clinical Features #
  • Cutaneous candidiasis is often described as burning, rather than itching, although symptoms may vary. 
  • Classically, it presents with bright red, striking erythema with associated satellite macules, papules, or pustules in skin folds. [1-3] 
Differential Diagnoses #
Diagnostic Workup #

Diagnostic workup for Candidiasis includes collecting a full history with concern for past medical history, recent antibiotic use, and hygiene protocol. Followed by KOH prep and/or fungal culture. A KOH prep may reveal pseudohyphae, but a fungal culture may be more sensitive for Candida. [1]  Skin biopsies are usually not warranted.  

Treatment #

Treatment for Candidiasis depends upon location and severity of the infection. The oral antifungal, fluconazole, is the only evidence-based option for systemic treatment of cutaneous candidiasis. [1] Topical antifungal agents that can be used include imidazole (miconazole, clotrimazole, econazole) or polyenes (nystatin). [1] Anti-inflammatory agents, such as desonide ointment or 1% hydrocortisone can be added to treatment regimen after a treatment course of antifungals to reduce residual itching and burning symptoms. [1]

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/
References #
  1. Taudorf, E H et al. “Cutaneous candidiasis – an evidence-based review of topical and systemic treatments to inform clinical practice.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 33,10 (2019): 1863-1873. doi:10.1111/jdv.15782 
  2. Sei, Yoshihiro. “2011 epidemiological survey of dermatomycoses in Japan.” Medical mycology journal 56.4 (2015): J129. 
  3. Tüzün, Yalçın et al. “Diaper (napkin) dermatitis: A fold (intertriginous) dermatosis.” Clinics in dermatology vol. 33,4 (2015): 477-82. doi:10.1016/j.clindermatol.2015.04.012 
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