Cutaneous Candidiasis

Candidiasis is an infection that is most frequently caused by the yeast Candida albicans, but other species with increasing frequency can cause human disease. Candida species are part of the normal inhabitants of the gastrointestinal tract but rarely colonize the skin unless there is a break in the integument. Candida species are dimorphic fungi that exist in both hyphal and yeast forms. Any factor that adversely affects the immune system may predispose a person to candidiasis, including pregnancy, the neonatal period, immunologic or endocrine dysfunction, debilitated states, corticosteroids, and immunosuppressive agents.


Tinea versicolor is a rash caused by fungus that usually lives on the skin. Teenagers and young adults can get it, more often in warmer weather, because fungus grows easily in heat and humidity. Unlike similar infections, tinea versicolor won't be passed among people.

Your doctor may prescribe a cream, lotion, or pills to treat the rash. Treatment may last up to 1 month, but your skin may take several months to return to normal. So don't be discouraged if it doesn't look normal after a few weeks.

Sunlight may help your rash, but ask your doctor whether being in the sun is good for you, and if so, how long you should stay in the sun. Using sunscreen is also important.

Don't scratch at the rash. If the itching really bothers you, talk to your doctor about medicine to help relieve it.

The rash occurs on the upper arms, chest, back, and neck and sometimes the face. The rash can be various colors and has small, white-to-pink or tan-to-dark spots with sharp edges and scales.

Your doctor makes a diagnosis by seeing the usual appearance of the rash on the skin. Your doctor may take a small scraping of a patch for study with a microscope if the diagnosis isn't clear.

Figure 22-6 Managing tinea versicolor.

Humidity, heat, and friction between skin surfaces are environmental factors that also may play a role.

Superficial candidiasis frequently manifests with pruritic lesions that may begin as vesicles, pustules, or erythematous plaques and eventually lead to maceration and fissuring, leaving behind a denuded, erythematous base. Often there are red satellite pustules surrounding the primary area. The usual sites for cutaneous Candida infection include the mouth (thrush), inter-triginous areas (Candida intertrigo), perineal region (Candida diaper dermatitis), periungual area (paronychial candidiasis), and genital region.

KOH microscopy of scrapings from lesions will usually reveal yeast and hyphae consistent with candidiasis. Material may be sent on Sabouraud dextrose agar for confirmatory fungal culture. Treatment involves the use of the appropriate topical and/or oral antifungal agent. Heat, humidity, and tight fitting clothing should be avoided. Moist or occluded areas must be “dried out.” Underlying diseases such as diabetes should be identified and controlled. Numerous effective topical agents are currently available. Nystatin is commonly used. Topical azole antifungal therapy applied once or twice daily for approximately 2 weeks is also quite effective.

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  • Category: Infectious diseases