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

• Particularly likely to occur in patients with diabetes or obesity, during pregnancy, and in setting of immunosuppression

• Antibiotics and oral contraceptive agents may be contributory

Demographics

• Oral candidiasis more common in older, debilitated, or malnourished patients, patients with diabetes or HIV infection, 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