Dermatologists and Skin Care

Candidiasis and Its Spectrum of Manifestation

Written by Dr. Suvash Sahu and medically reviewed by iCliniq medical review team.

 
Image: Candidiasis and Its Spectrum of Manifestation

An infection caused by the yeast (fungus), Candida albicans is known as candidiasis. This infection is usually confined to the skin, nail, mucus membranes and gastrointestinal tract. But, it can also infect internal organs and cause systemic disease.

Candida albicans is an oval yeast, which divides by budding. Apart from its yeast form, it is capable of producing long chains of elongated cells (pseudohyphae) and occasionally continuous hyphae with cross walls. This ability to exist in hyphal as well as yeast forms is known as dimorphism. Both, male and female are equally prone to get affected in all ages.

Certain Facts about Candidiasis:

Candida albicans, the causative yeast is an opportunist par excellence. It flourishes in the warmth and moisture provided by the body-folds, damaged nail cuticle due to prolonged contact with soap and water, altered vaginal pH, neonates, infants, malnourished, debilitated and the immunocompromised (HIV infection, diabetes mellitus, leukemia, steroid or immunosuppressive therapy) individuals.

Redness, tiny superficial pustules (pus filled lesions), erosions and overlying curdy white discharge are the typical presentation of candidiasis. Oral thrush, vulvovaginitis, intertrigo, paronychia and balanoposthitis are some of its common manifestations.

Predisposing Factors of Candidiasis:

Candida albicans, usually a harmless resident of throat, gut and vagina, is a barometer of defective immunity causing opportunistic clinical infection during the following conditions.

  1. Maceration of skin due to climate or clothing.
  2. Eczema.
  3. Dentures (oral candidiasis).
  4. Diabetes.
  5. Pregnancy.
  6. Corticosteroids.
  7. Broad spectrum antibiotics.
  8. Malignancy.
  9. HIV.

Disease Presentation:

Skin:

Moist and macerated axilla, genitocrural, interdigital and inframammary folds are predominantly involved with itchy red areas having satellite vesicles and pustules.

Oral:

Oral candidal involvement can be acute pseudomembranous or acute atrophic.

  • Acute pseudomembranous (thrush) occurs as white curd like patches mostly over the tongue, buccal mucosa, palate and gingiva. It can be scraped off leaving a raw bright red surface and is the commonest type.
  • In acute atrophic, raw erythematous area is seen in people with HIV infection. Erythematous candidiasis is the most common manifestation in AIDS patients, affecting the dorsal tongue or palate presenting with bright red patches
  • Oral candidiasis is a common, early and often initial manifestation of HIV.
  • Oral infections that may predict the onset of other serious opportunistic diseases are angular cheilitis - fissuring of angles of the mouth, chronic hyperplasia - adherent white patches with surrounding erythema, median rhomboid glossitis - a central papillary atrophic condition of the tongue and black hairy tongue - hypertrophic papillae on the tongue.

Genital:

  1. Balanitis or balanoposthitis: Small papules and pustules appear on the glans, prepuce or coronal sulcus and soon breakdown to leave superficial erythematous erosions with a surrounding collarette of scales.
  2. Vulvovaginal: Thick, creamy vaginal discharge associated with burning or itching.

Nails - Paronychia:

Redness, swelling and tenderness in the paronychial area.

Laboratory Diagnosis:

1. Scraping:

10% KOH (potassium hydroxide) mounts of the scrapings from the suspected site examined under a microscope reveal candida as oval budding and elongated filamentous cells connected in sausage like manner (pseudohyphae).

2. Culture:

In Sabouraud dextrose agar (SDA), whitish mucoid colonies grow within two to five days.

Treatment:

  • For oral candidiasis, topical treatment includes Nystatin suspension (4,00,000 to 6,00,000 U) QID held in the mouth and then swallowed, Clotrimazole mouth paint and Gentian violet 1% to 2% local application.
  • Systemic treatment for oral candidiasis can be any one of the following. Tablet Ketoconazole 200 mg per day for 1 to 2 weeks (in AIDS the dose is 400 mg per day) or tablet Fluconazole 50 mg to 100 mg per day for seven days or tablet Itraconazole 100 mg per day for 14 days.
  • For vulvovaginal candidiasis, Clotrimazole suppository 500 mg HS and tablet Fluconazole 150 mg stat.
  • For balanitis, Clotrimazole topical cream and tablet Fluconazole 150 mg stat.
  • For skin, Nystatin cream and Miconazole cream topical.
  • For nails, Miconazole topical and oral Ketoconazole or Fluconazole.

For the treatment to be effective, correction of predisposing factors is essential along with exhibition of topical or systemic antifungals in unresponsive or immunocompromised patients.

For further knowledge of candidal infection consult a fungal infection specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/fungal-infection

Last reviewed at: 07.Sep.2018

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