Candidal Intertrigo Treatment

 Candida Intertrigo (Candidiasis of Large Skinfolds)

Description

  • Pink to red maceration, occurring where two skin folds come together. 
  • Warm moist environment leads to disruption of the skin barrier, predisposing to yeast infection.
    Candida-Intertrigo

History

  • Predisposing factors include obesity, immunodeficiency (e.g. diabetes, prednisone), hot humid weather, poor hygiene, tight-fitting clothing, and use of topical steroids.

Skin Findings

  • Red moist, glistening plaques with satellite pustules and papules with a fringe of white scale. 
  • Painful fissures frequently occur deep within the skin folds.

Laboratory

  • Potassium hydroxide wet mount preparation from a pustule or scaly border shows spores and pseudohyphae.
  • Skin biopsy and a surface culture may be necessary in treatment-resistant cases.

Course and Prognosis

  • Candida intertrigo usually recurs if the underlying conditions are not corrected.

Differential Diagnosis

  • Inverse psoriasis
  • Seborrheic dermatitis
  • Erythrasma
  • Streptococcal infection
  • Irritant contact dermatitis

Treatment

  • Apply wet dressings (tap water or Burow’s solution [aluminum acetate 1 : 40 solution]) with a soft cotton cloth for 20 minutes several times per day to soothe and dry the area.
  • Application of an antiyeast cream (e.g. nystatin) or an antifungal (e.g. econazole) cream should be applied twice daily in a thin layer.  
  • Oral antifungal agents (e.g. fluconazole 100–200 mg per day for 1 week) treat resistant or severe cases.
  • Sealing in the skin with a light moisturizer (e.g. Vanicream Lite or Lubriderm) may prevent recurrences by decreasing friction and acting as a protective barrier.
  • Powders may be helpful to wick away moisture but may clump if there is excessive moisture.
  • Patients should be encouraged to lose weight and avoid tight-fitting clothing.

Pearls

  • Nystatin is not effective for dermatophyte infections, and griseofulvin and terbinafine are not effective for yeast infections.
  • Consider streptococcal infection if the rash is painful and malodorous.
  • Topical corticosteroid use may predispose to yeast and dermatophyte infection.
  • Patients who do not respond to antiyeast medications may have inverse psoriasis.

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