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Candidiasis in Adult
Other Resources UpToDate PubMed

Candidiasis in Adult

Contributors: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
Other Resources UpToDate PubMed


Candidiasis refers to a variety of infections caused by Candida albicans (in 70%-80% of cases) or any of the 200 other yeasts in this genus. Candida albicans is also a normal commensal and colonizes the oropharynx of up to 50% of asymptomatic people. The clinical presentations of candidal infection can be separated into those affecting the mucous membranes, cutaneous syndromes, and those with deep visceral involvement. Mucous membrane infections include thrush, or oral candidiasis, Candida epiglottitis and esophagitis, and vaginal and vulvovaginal candidiasis.

Cutaneous candidiasis includes generalized cutaneous candidiasis, intertrigo, erosio interdigitalis blastomycetica, Candida miliaria, and Candida of the genitalia, including candidal balanitis and perianal skin. Paronychia and onychomycosis, diaper dermatitis, and chronic mucocutaneous candidiasis, which are also part of the cutaneous syndromes, are discussed separately.

Deep visceral involvement occurs with disseminated or systemic candidiasis.

Chronic mucocutaneous candidiasis is a genetic syndrome linked to defective cell-mediated immunity to Candida antigens and results in patients developing recurrent candidal infections of the skin, nails, and mucous membranes. Skin lesions appear as hyperkeratotic erythematous plaques. The affected nails are thickened, brittle, yellow-brown in color, and have associated paronychia. Most cases are seen in childhood and adolescence.

Cutaneous candidiasis includes the following:
  • Generalized cutaneous candidiasis is an eruption of lesions covering the trunk, thorax, and extremities, which are accentuated in the genitocrural folds and around the anus, as well as the axilla, hands, and feet. Skin is erythematous, and lesions are initially discrete and then coalesce into larger lesions. Fissuring of the skin may be present.
  • Intertrigo occurs at locations at which the skin surfaces are closely apposed to each other. The most common sites are the axillary, inframammary, gluteal, and genitocrural regions. Intertrigo occurs due to widespread colonization, especially of macerated folds of moist skin. This usually presents as inflammation of the skin folds and starts as vesicles and pustules. The skin appears erythematous with surrounding vesicles and pustules.
  • Candida miliaria affects the backs of bedridden patients with lesions in the form of vesicles and pustules.
  • Erosio interdigitalis blastomycetica is a candidal infection of the web spaces of the fingers and the toes. The skin lesions appear red and macerated and may extend onto the sites of the digits. Pustules may also be present. The toxic dermatitis initiated by Candida species is usually followed by infection with gram-negative rods exacerbating the chronicity of the lesion.
  • Candida folliculitis is an infection of the hair follicles. Although usually localized, it may become widespread and must be differentiated from folliculitis due to dermatophytes and tinea versicolor.
  • Candida balanitis is seen as vesicles on the penis that cause intense itching and burning. The lesions may also spread to the scrotum, thighs, and gluteal folds.
  • Angular cheilitis can be caused by candidal infection of the angles of the mouth and results in macerated skin with deep creases and crust formation.
Disseminated candidiasis usually only occurs in patients who are immunocompromised. Organs commonly affected include the liver and spleen, predominantly followed by the kidney, retina, and heart valves. Cutaneous lesions of disseminated candidiasis are of 3 characteristic varieties. They may be macronodular lesions, lesions resembling ecthyma gangrenosum, and lesions resembling purpura fulminans. The typical cutaneous manifestations of disseminated candidiasis are usually situated on the trunk and extremities and include erythematous papules with a pustular or hemorrhagic center.

Factors that predispose to cutaneous candidiasis include obesity, endocrine disease such as diabetes or Cushing syndrome, and tight clothing. Other predisposing factors include patients on broad-spectrum antibiotics, steroid therapy, indwelling catheters, recent surgery, chemotherapy, or radiation. Immunocompromised individuals are also susceptible. The very young and the elderly are also predisposed to candidal colonization.

Nosocomial infection with some Candida species (eg, Candida auris) has been associated with prolonged use of axillary temperature monitors.


B37.2 – Candidiasis of skin and nail

78048006 – Candidiasis

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Last Updated:10/11/2018
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Candidiasis in Adult
Candidiasis : Burning skin sensation, Erythema, Inframammary fold of chest, Macerated skin, Inguinal region, Pustules
Clinical image of Candidiasis
Erosio interdigitalis blastomycetica showing a macerated and eroded plaque at the finger web.
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