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Key Features

Essentials of Diagnosis

  • Severe pruritus of vulva, anus, or body folds

  • Superficial denuded, beefy-red areas with or without satellite vesicopustules

  • Whitish curd-like concretions on the oral and vaginal mucous membranes

  • Yeast on microscopic examination of scales or curd

General Considerations

  • Superficial fungal infection that may involve almost any cutaneous or mucous surface of the body

  • Particularly likely to occur in diabetic patients, during pregnancy, in obese persons, and in setting of immunosuppression

  • Antibiotics and oral contraceptive agents may be contributory

Demographics

  • Oral candidiasis more common in elderly, debilitated, malnourished, diabetic, or HIV-infected patients as well as those taking antibiotics, systemic corticosteroids, or chemotherapy

Clinical Findings

Symptoms and Signs

  • Itching may be intense

  • Burning is reported, particularly around the vulva and anus

  • Lesions consist of superficially denuded, beefy-red areas in the depths of the body folds

    • Groin and the intergluteal cleft

    • Beneath the breasts

    • Angles of the mouth

    • Umbilicus

  • The peripheries of the denuded lesions are superficially undermined, and there may be satellite vesicopustules

  • Whitish, curd-like concretions may be present on the surface of the mucosal lesions

  • Paronychia and interdigital erosions may occur

  • Lancinating breast pain and nipple dermatitis in breastfeeding women may be a manifestation of Candida colonization/infection of the breast ducts

Differential Diagnosis

  • Cutaneous candidiasis

    • Intertrigo

    • Seborrheic dermatitis

    • Tinea cruris (jock itch)

    • Psoriasis of body folds ("inverse psoriasis")

    • Erythrasma

    • Contact dermatitis

    • Tinea versicolor (pityriasis versicolor) (rarely)

  • Oral candidiasis

    • Leukoplakia

    • Lichen planus

    • Dysplasia or carcinoma

    • Geographic tongue

    • Herpes simplex

    • Erythema multiforme

    • Pemphigus

    • Oral hairy leukoplakia

Diagnosis

Laboratory Tests

  • Clusters of budding yeast and hyphae can be seen under high power (400×) when skin scales or curd-like lesions have been cleared in 10% KOH

Treatment

Medications

Table 6–2.Useful topical dermatologic therapeutic agents.

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