Cutaneous Candidiasis 
Basics
Cutaneous candidiasis is a superficial fungal infection of the skin and mucous membranes. The organism, C. albicans thrives in moist, occluded sites, and is most likely to proliferate in:
Those who continually expose their hands to water (e.g., dishwashers, health care workers, florists).
Obese persons/patients with HIV/AIDS/patients with polyendocrinopathies
Infants (see discussion in Chapter 2: Neonatal and Infantile Eruptions).
Clinical Variants
Most often arises in intertriginous areas, such as under pendulous breasts (Fig. 18.17), in the axillae, groin, intergluteal fold, perineal region including the scrotum (Fig. 18.18) and at the corners of the mouth (perlèche).
Initially, pustules appear, followed by well-demarcated erythematous plaques with small papular and pustular lesions at the periphery (“satellite pustules”).
Lesions are not annular (they have no central clearing), as seen in tinea infections.
“Erosio interdigitalis blastomycetes.” Superficial interdigital scaly, erythematous erosions or fissures occur in the web spaces of the fingers (Fig. 18.19).
Candidal diaper dermatitis occurs in the area occluded under diapers (see Chapter 2: Neonatal and Infantile Eruptions).
Candidal folliculitis is characterized by follicular pustules.
Candidal balanitis (Fig. 18.20) and balanoposthitis are seen in men with diabetes. Various clinical findings such as erythema, edema, papules, pustules, and moist curd-like accumulations may appear with fissuring, erosions, and ulceration of the glans and foreskin.
Candidal vulvitis/vulvovaginitis consists of itchy, erosions, pustules, and erythematous plaques.
Candidal paronychia is characterized by edema, erythema, and purulence of the proximal nail fold with secondary nail dystrophy (discussed in Chapter 22: Diseases and Abnormalities of Nails).
Oral candidiasis (“thrush”) is distinguished by white (Fig. 18.21), creamy exudate or plaques, which, when removed, appears eroded and beefy red. Oral candidiasis appears in infants (“thrush”) and in the clinical settings of immunosuppression and diabetes (see Chapters 2 and 33).
Diagnosis
KOH positive for pseudohyphae, budding yeast, or mycelia (Fig. 18.22) (also see Chapter 35: Diagnostic and Therapeutic Techniques).
Fungal culture on Sabouraud's media reveals creamy, dull-white colonies.
Differential Diagnosis
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Management 
Helpful Hint 
Points to Remember Basics
Tinea versicolor (TV), referred to as pityriasis versicolor by many authors, is a very common superficial yeast infection caused by the hyphal form of Pityrosporum ovale. The organism is also known as P. orbiculare and Malassezia furfur.
TV is seen mostly in young adults and is unusual in the very young and elderly.
The term “versicolor” refers to the varied coloration that TV can display, even on the same individual. The color of the lesions may vary from whitish to pink to tan or brown (Figs. 18.23-18.25). It tends to be a chronic relapsing condition because the causative fungus is part of the skin's normal flora.
Clinical Manifestations
Primary lesions are well-defined round or oval patches with an overlay of fine, furfuraceous scales; lesions often coalesce to form larger patches.
Lesions most commonly appear on the trunk, upper arms, and neck and are less often seen on the face.
Common and persistent in consistently hot, tropical and subtropical climates.
Usually asymptomatic, but may itch in hot weather or when patient is sweating.
Diagnosis
If scale is present, KOH examination is positive, and the typical “spaghetti and meatball” hyphae are abundant and easily found (Figs. 18.26 and 18.27).
Lesions of TV will fluoresce an orange-mustard color when the Wood's light is held close to the skin in a dark room. Examination with a Wood light can be used to demonstrate the extent of the infection and help confirm the diagnosis.
Pityriasis Rosea (see Chapter 15: InflAMmatory Eruptions of Unknown Cause) |
Topical Agents
Systemic Therapy
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