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 and pseudohyphae on microscopic examination of scales or curd.
Mucocutaneous candidiasis is a superficial fungal infection that may involve almost any cutaneous or mucous surface of the body. It is particularly likely to occur in diabetic patients, during pregnancy, in obese persons, and in the setting of immunosuppression. Systemic antibiotics, oral corticosteroids, hormone replacement therapy, and oral contraceptive agents may be contributory. Oral and interdigital candidiasis may be the first sign of HIV infection (see Chapter 31-04). Denture use predisposes the elderly to infection. Abnormalities in the IL-17, IL-22, mannose-binding lectin, and toll-like receptors have all been implicated in predisposing patients to Candida infection of the skin and mucous membranes.
Itching may be intense. Burning is reported, particularly around the vulva and anus. The lesions consist of superficially denuded, beefy-red areas in the depths of the body folds, such as in the groin and the intergluteal cleft, beneath the breasts, at the angles of the mouth(eFigure 6–61), in the webspaces of digits, and in the umbilicus. The peripheries of these denuded lesions are superficially undermined, and there may be satellite vesicopustules. Whitish, curd-like concretions may be present on mucosal lesions (Figure 6–22). Paronychia may occur.
Angular cheilitis (perleche). (Used, with permission, from Lindy Fox, MD.)
Oral mucosal candidiasis. (Used with permission from Sol Silverman, Jr, DDS, Public Health Image Library, CDC.)
Clusters of budding yeast and pseudohyphae can be seen under high power (400×) when skin scales or curd-like lesions are mounted in 10% KOH (eFigure 6–25). Culture can confirm the diagnosis.
Intertrigo (eFigure 6–18), seborrheic dermatitis, tinea cruris, “inverse psoriasis” (eFigure 6–31), and erythrasma involving the same areas may mimic mucocutaneous candidiasis (eFigure 6–32).
Systemic invasive candidiasis with candidemia may be seen with immunosuppression and in patients receiving broad-spectrum antibiotic and hypertonic glucose solutions, as in hyperalimentation. There may or may not be clinically evident mucocutaneous candidiasis.
Affected parts should be kept dry and exposed to air as much as possible. Water immersion should be minimized and gloves should be worn for those with infected nails or digital skin. If possible, discontinue systemic antibiotics. ...