Candidiasis, Mucocutaneous

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

• See Table 6–2