Cutaneous candidiasis is a yeast infection of the skin, usually by Candida albicans, that thrives in warm, moist skin folds. Risk factors include obesity, diabetes, diapers, antibiotics, corticosteroids and a weak immune system.
Key symptoms
- Itchy, burning red rash in skin folds
- Soreness and moist skin
- Diaper rash that does not improve with barrier cream
- Cracks at the corners of the mouth or redness between the fingers
What you find on exam
- Bright red, moist plaques in the groin, under the breasts, in belly folds or the diaper area
- Small red papules and pustules beyond the edge (satellite lesions)
- Diaper candidiasis involves the skin folds, unlike irritant diaper rash
- Check the mouth for thrush and the nails for paronychia
Tests
- Often a clinical diagnosis
- KOH prep showing budding yeast and pseudohyphae
- Fungal culture if recurrent or not responding
- Glucose or HbA1c if recurrent, to look for diabetes
Treatment basics
- Topical azole such as clotrimazole or miconazole, or topical nystatin, for about 2 weeks
- Keep the area clean and dry; absorbent powder and loose clothing
- Oral fluconazole for extensive or resistant infection
- Treat risk factors: control glucose, change diapers often, review antibiotics and steroids
Red flags
- Widespread or recurrent infection (look for diabetes or immunosuppression)
- Fever or sick appearance in an immunosuppressed patient (consider invasive candidiasis)
- No improvement after 2 weeks of treatment (reconsider the diagnosis)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.