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. For treatment of systemic invasive candidiasis, see Chapter 36.
Apply clotrimazole solution 1% twice daily. Thymol 4% in ethanol applied once daily is an alternative.
Apply either nystatin ointment or clotrimazole cream 1%, with hydrocortisone cream 1%, twice daily. Gentian violet 0.5% solution is economical and highly effective in treating mucocutaneous candidiasis, but the purple discoloration may represent a cosmetic issue. Severe or widespread cutaneous disease responds to fluconazole, 100–200 mg orally daily, for 1 week.
3. Vulvar and anal mucous membranes
For vaginal candidiasis, single-dose fluconazole (150 mg orally) is effective. Intravaginal clotrimazole, miconazole, terconazole, or nystatin may also be used. Long-term suppressive therapy may be required for recurrent or “intractable” cases. Non-albicans candidal species may be identified by culture in some refractory cases and may respond to oral itraconazole, 200 mg twice daily for 2–4 weeks.
This is most frequent in uncircumcised men, and Candida usually plays a role. Topical nystatin ointment is the initial treatment if the lesions are mildly erythematous or superficially erosive. Soaking with dilute 5% aluminum acetate for 15 minutes twice daily may quickly relieve burning or itching. Chronicity and relapses, especially after sexual contact, suggest reinfection from a sexual partner who should be treated. Severe purulent balanitis is usually due to bacteria. If it is so severe that phimosis occurs, oral antibiotics—some with activity against anaerobes—are required; if rapid improvement does not occur, urologic consultation is indicated.
Lancinating breast pain and nipple dermatitis in breast-feeding women may be a manifestation of Candida colonization/infection of the breast ducts. Topical nystatin cream and clotrimazole 0.1% cream are safe during lactation. Topical gentian violet 0.5% daily for 7 days is also useful. Oral fluconazole, 200 mg daily for 2 weeks, can be dramatically effective and is also safe during lactation.