Candidiasis in Adult
Alerts and Notices
Synopsis
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 where 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. See male genital candidiasis.
- 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.
- Mammary candidiasis may occur during breastfeeding. It has a subtle presentation, with cracking and erythema of the nipple and surrounding areola. It may contribute to pain, burning, and discomfort with nursing. Often, oral thrush is noted in the nursing infant, which contributes to the development of mammary candidiasis.
Nosocomial infection with some Candida species (eg, Candida auris) has been associated with prolonged use of axillary temperature monitors.
Related topic: disseminated candidiasis (systemic candidiasis)
Codes
ICD10CM:B37.2 – Candidiasis of skin and nail
SNOMEDCT:
78048006 – Candidiasis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Folliculitis
- Intertrigo – In candidal intertrigo, the presence of outlying satellite papules and/or pustules is diagnostic.
- Contact dermatitis
- Irritant dermatitis
- Seborrheic dermatitis
- Erythrasma
- Tinea cruris
- Impetigo
- Exanthematous drug eruption
- Leukoplakia
- Herpes simplex virus (HSV)
- Atopic dermatitis
- Lichen sclerosus
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:08/16/2021
Last Updated:02/14/2022
Last Updated:02/14/2022
Patient Information for Candidiasis in Adult
Overview
Candidiasis, commonly known as a yeast infection, is an infection with the common yeast (or fungus) organism, Candida albicans, which is commonly found in the environment. Sometimes this yeast lives in the mouth, digestive (gastrointestinal) tract, and the vagina, along with many kinds of harmless bacteria, without causing any issues. However, under certain conditions (particularly weakening of the immune system, the use of antibiotics, exposure to cancer drugs or corticosteroids, or in diabetics), the fungus will multiply and cause disease.There are different forms of yeast infection, depending upon the area affected. Most commonly, the mouth, vagina, and damper skin areas are affected, as the yeast likes to grow in moist areas.
Most yeast infections are on the surface (superficial) and easily treated; however, serious life-threatening yeast infection can develop throughout the body (systemic) in people with very weak immune systems.
Who’s At Risk
Various species of Candida yeast grow in over half of healthy adults.- Men and women are affected equally.
- People with weakened (suppressed) immune systems, who use antibiotics, take cancer drugs or corticosteroids, or are diabetic are more likely to develop a yeast infection.
- Older people are more likely to get thrush (oral candidiasis).
- In women, yeast infection is the second most common cause of inflammation of the vagina (vaginitis).
- Long-lasting (persistent) symptoms and yeast infection that does not heal may be the first sign of infection with HIV.
Signs & Symptoms
The appearance and symptoms of yeast infection depend upon the area affected.The most common types of infection are:
- Thrush (oral yeast infection) - The mouth lining, tongue, and/or angles of the mouth are red, cracked, or have white patches. There may be soreness or no symptoms. This is discussed separately.
- Skin (cutaneous) - Small-to-large patches of red, moist, raw skin usually develop in body creases, such as under the breasts, belly, or groin area. The skin may itch or be painful. Tiny pus-containing lesions (pustules) may appear around the edges of the red areas.
- Vaginitis - Vaginal itch, pain, or burning are frequent and may be accompanied by a cottage-cheese-like discharge. There is usually pain with sexual intercourse.
- Esophagitis - Swallowing may be painful, and there may be pain behind the breastbone.
Self-Care Guidelines
- Most yeast infections can be prevented by keeping body-fold areas clean and dry.
- Diabetics should keep their blood sugar under good control.
- Treat skin infection with a combination of an over-the-counter antifungal cream (such as clotrimazole or miconazole twice daily for 10-14 days) with hydrocortisone cream (0.5-1% applied twice daily after the antifungal cream).
- Lose weight if you are overweight.
- A NON-pregnant women can treat vaginitis with an over-the-counter vaginal suppository or cream antifungals (miconazole or clotrimazole). The woman's partner does not normally need treatment. Avoid sexual intercourse until the yeast infection heals.
When to Seek Medical Care
See your doctor if your symptoms do not go away with self-care.Remember that vaginitis can be caused by something other than yeast infection, and you might have a sexually transmitted disease if you are sexually active. See your doctor to confirm the diagnosis.
Treatments
Your doctor may prescribe oral antifungal medications for any form of yeast infection that does not improve with self-care measures.References
Bolognia, Jean L., ed. Dermatology, pp.1110-1111, 1185, 1837. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 2006. New York: McGraw-Hill, 2003.
Candidiasis in Adult