This summary is an overview of local mucocutaneous candidiasis. Local mucocutaneous 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 involving skin and mucous membranes. Candida albicans is also a normal commensal and colonizes the oropharynx of up to 50% of asymptomatic people. The clinical presentations of local mucocutaneous candidal infection include thrush (or oral candidiasis), Candida epiglottitis and esophagitis, vaginal and vulvovaginal candidiasis, 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 are also part of the mucocutaneous syndromes.

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.

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.

Related topic: disseminated candidiasis (systemic candidiasis)