About all

Can prednisone cause yeast infections: Yeast Infection Causes and Risk Factors


Yeast Infection Causes and Risk Factors

Three out of every four women will have at least one vaginal yeast infection at some point, and up to half of all women will have more than one. (1)

In other words, this type of vaginal infection is extremely common.

Yeast infections can occur in several places on the body. The most common areas are:

When a yeast infection develops in a woman’s vagina, it causes a type of vulvovaginitis, or inflammation of the vulva and vagina.

Vaginal yeast infections are also known as vaginal candidiasis, vulvovaginal candidiasis, and candidal vaginitis. (3)

Yeast — a single-celled fungus — can also cause infection in overweight people who have folds of skin that rub against each other, creating a dark and moist environment in those folds. These infections are called candidal intertrigo. (4)

We normally have yeast all over our bodies and in our guts, and it plays an important role as it lives side by side with bacteria.

“When there is an imbalance in the normal flora [environment] of the vagina, the yeast can grow heavier and cause what we know of as a symptomatic yeast infection,” says Rosanna Gray-Swain, MD, an obstetrician-gynecologist in St. Louis.

“In the vagina, these symptoms usually include itching, discharge, redness, and burning,” she says. (3)

What Causes Vaginal Yeast Infections?

Candida albicans is a species of yeast that’s a normal part of the microbes that live in your gastrointestinal tract.

Small amounts of the yeast also live in various warm, moist areas throughout the body, including the mouth, rectum, vagina, and parts of your skin.

C. albicans is not the only species from the Candida genus that lives in the body. Other common species include C. glabrataC. parapsilosisC. tropicalis, and C. krusei.

These five species of yeast cause more than 90 percent of vaginal yeast infections, but most of these infections are due to C. albicans. (5)

Some studies estimate that about 20 percent of asymptomatic, healthy women have Candida living in their vaginas, according to a report published in the journal The Lancet. (1)

But C. albicans comprises 85 to 95 percent of the Candida yeast strains isolated from the vagina, the report notes.

An overgrowth of C. albicans (or other Candida species) in the vagina causes a yeast infection.

Candida species also cause thrush and candidal intertrigo (Candida is commonly found in the mouth but not on the skin, except in warm, moist areas).

But athlete’s foot is caused by different fungal species, in particular Trichophyton rubrum, T. interdigitale, and Epidermophyton floccosum. (6)

How Yeast Infections Develop

Your body is normally very good at regulating itself, maintaining all the right chemical levels for good functioning.

Additionally, the population of C. albicans is naturally kept in check by the bacteria and other microorganisms that make up your microbiome, the community of microorganisms that inhabit your body.

Sometimes, though, problems will occur that alter that chemistry, throwing certain bodily functions off-balance, as well as disturbing the microbial balance.

When this happens, the scales may tip in favor of C. albicans, allowing the fungus to grow out of control and cause a yeast infection. (1)

Common symptoms of vaginal yeast infections include:

  • Vaginal itching and a burning sensation in the vaginal region, including the labia and vulva
  • White vaginal discharge that’s sometimes described as being similar in consistency to cottage cheese (but does not smell)
  • Pain during urination or sex
  • Redness and swelling of the vulva (7)

What Lifestyle Factors Contribute to Yeast Infections?

A variety of lifestyle factors may contribute to the development of a vaginal yeast infection.

For example, wearing tight underwear or underwear made from a synthetic fabric that doesn’t let the area “breathe” encourages yeast overgrowth. Absorbent cotton or silk underwear is best.

Additionally, failing to promptly change out of wet swimsuits or exercise clothing fosters an environment perfect for yeast growth.

Using certain over-the-counter feminine hygiene products, such as douches, scented sprays, and even bubble bath, may disrupt the natural microbial balance in the vagina, resulting in a yeast infection. (8)

Being overweight can also contribute to yeast infections, both in the vagina and in the folds of the genital area, as can eating a diet high in sugar (a food source for yeast).

What Medical Conditions Can Increase Infection Risk?

Many women get their first yeast infection when they are pregnant or are on birth control pills.

Some women get vaginal infections from yeast overgrowth when they have their periods, due to hormonal changes (yeast infections are less common in postmenopausal women and girls who have yet to menstruate).

If you have diabetes, you may also find that you experience frequent or chronic yeast infections if your blood sugar is not well controlled.

Illnesses that lower your immunity, like HIV or AIDS, can also lead to frequent yeast infections. (9)

How Antibiotics and Yeast Infections Are Connected

Some antibiotics are known to encourage yeast overgrowth by killing off normal genital bacteria, which throws off the balance of the vaginal microbial community and makes it easier for yeast to thrive.

Still, most women who take antibiotics do not develop symptomatic yeast infections. This risk is typically only associated with the 20 percent of women who are already colonized with Candida. (1)

Using probiotics while on antibiotics may help by restoring good bacteria.

The best sources of probiotics are organic yogurt with live bacterial cultures and supplements that contain “good” bacteria — look for the words “lactobacillus” or “acidophilus” on the label.

Note that solid evidence showing probiotics help prevent yeast infections is lacking. But there’s little harm in trying probiotics. (10)

How Steroids and Yeast Infections Are Connected

Steroids are another type of medication that can cause people to develop an infection from yeast.

The higher the dose and the longer you use them, the greater the risk, but even low-strength topical steroid creams may make yeast infections more likely by damping the body’s natural immune defenses. (11)

The good news is that most yeast infections are easily treated with antifungal creams or suppositories purchased over the counter or through prescription.

If you think you have a vaginal yeast infection, speak with your doctor to discuss your treatment options.

It’s not recommended for women to use OTC creams before getting diagnosed by their doctors, because the symptoms of yeast infections are similar to those of other vaginal infections, such as bacterial vaginosis.

Most yeast infections subside within a few days after treatment starts. (3)

Medications that Weaken Your Immune System and Fungal Infections | Fungal Infections | Fungal

Overall, most serious fungal infections are rare, but they do happen. They are most common among people with weak immune systems. People with certain health conditions may need to take medications with side effects that can weaken your immune system and put you at risk for fungal infections.

Specifically, corticosteroids and TNF (tumor necrosis factor) inhibitors are two types of medications that can increase your chances of getting a fungal infection.1

Some fungal infections can be serious, such as:

Other fungal infections, such as oral candidiasis (thrush), are usually not life threatening.11

What you need to know about fungal infections

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can have serious complications. Because of this, it’s important for you to seek treatment as soon as possible to avoid serious infection.

Fungal infections can look like bacterial or viral infections. If you’re taking medicine to fight an infection and you aren’t getting better, ask your doctor about testing you for a fungal infection.

Where you live (geography) matters. Some disease-causing fungi are more common in certain parts of the world. If you live in or visit these areas and are taking medications that weaken the immune system, you’re more likely to get these infections than the general population.7, 8, 12 For more information on travel-related illnesses, please see the CDC Traveler’s Health site.

The length of your treatment matters. Your healthcare provider can prescribe corticosteroids for short-term use (days to weeks) or long-term use (weeks to months). Long-term corticosteroid use is more likely to increase your chance of getting a fungal infection.

Amount of medication (dose). Higher doses of medications that weaken your immune system are more likely to increase your risk of getting a fungal infection.5, 11, 13, 14

Click on the sections below to see lists of corticosteroids and TNF inhibitors that can increase the chances of getting a fungal infection.

Could You Have This Chronic Infection and Not Even Know It?

A few years ago, I lay in a hospital bed wishing for the daily dose of prednisone that would ease my body’s lupus-induced pain.  As gobs of prednisone streamed into my veins, the last thing on my mind was the havoc this pain-reducing medication would wreak.

As I discovered, immunosuppressant drugs like prednisone can zap your adrenals (which, by the way, can be recovered) and help a little organism called candida flourish in your body. Candida can flourish anywhere: your gut, your private areas, your mouth. And, this little critter can be very difficult to get rid of.

Candida, more commonly known as a type of yeast, is a fungus and exists in the mouth and intestines in small amounts.

Normally, our bodies keep the candida population under control. But, when we take antibiotics, our body can’t regulate the fungus as well as it normally does. This is why women commonly get yeast infections after taking antibiotics.

What makes Candida grow?

Since candida is a fungus, it needs food and an immune system that can’t keep up in order to grow. Here are a few of the most common causes of candida:

  • Birth control pills
  • Prednisone (and other immunosuppressants)
  • Alcohol
  • Antibiotics
  • Diet high in sugar and carbs
  • Eating or drinking fermented foods like Kombucha, pickles and sauerkraut

How do you know if you have Candida?

There are several ways to tell if you have Candida. Here’s a fairly long list of possible symptoms:

  • Any nail or skin fungal infections, on the feet or toenails
  • Eczema, hives, rashes, psoriasis
  • Digestive issues like diarrhea or constipation or bloating
  • Autoimmune disorders such as lupus, psoriasis, MS, ulcerative colitis, Hashimoto’s thyroiditis make a body much more susceptible
  • Vaginal infections or itching, anal itching or urinary tract infections
  • Fatigued, feeling run down, fibromyalgia
  • Itchy inner ears
  • Craving for sugar and carbohydrates
  • Brain fog, inability to concentrate, memory issues, ADD
  • Anxiety, depression, irritability and mood swings.

Do any of these sound familiar? If you think you may have candida, it’s best to get checked out by your primary care provider. There are blood and stool tests that can be performed.

If you find out you have Candida, there are two ways to handle it.

Available at Amazon.com

One is to get on a strictly yeast-free diet for 2 weeks plus take some form of anti-candida medication. At times, this can be a prescription, such as Diflucan or Nyastatin, or oil of oregano, which is available over the counter.

Typically I have found that an over the counter medication is not as effective as a prescription. Yeast can be quite challenging to get rid of and you will need to be on either a prescription or both for at least 4-6 weeks. Sugar feeds the candida and therefore easily flourishes.

Along with a yeast-free diet, you will also need to avoid all sugars, alcohols, carbohydrates and even some fruits. Candida feeds on sugar and carbs, so eliminating them from your diet will essentially starve out the Candida.

There are tons of books on the Candida Diet and lots of information on the web. The first 2 weeks are the strictest and most difficult, but are critical to fighting off candida.

Probiotics are great too and help to balance out the pH. Taking at least 25 billion units upon waking and at bedtime is very beneficial.

What you will notice once you have begun treatment:

  • Clearer skin
  • Less bloating and gas
  • Regular bowel movements
  • More energy
  • Lessening of fibromyalgia
  • Less sugar cravings
  • Possibly a little weight loss
  • Eczema and skin rashes clearing up

So it’s vital to find out if you are carrying around this infection, which can become chronic. You will feel the difference in your body.

Have you ever been diagnosed? How did you feel after the treatment? Did treating it make a difference in your well being? I’d love to know.

Speak to you soon,

Treating Yeast Infections | Pooch Dog Spa News

One of the biggest asks from dog owners is how do they stop their pet from constantly scratching. As a dogs skin is indicative of its overall health, constant itching and scratching is a symptom of an underlying problem. To rid a dog of this misery you have to identify the source of the problem to effectively treat it and prevent future recurrences.

Most fungal infections are caused by a type of yeast call Malassezia. This yeast is a normal part of the flora of the body and lives in minute amounts in a dog’s ears, skin and mucus membranes. As long as the body is in balance all is well. An overgrowth of this yeast can be caused by an underactive immune system or an overactive immune response where allergies are present due to overuse of antibiotics and medication, vaccinations, chemicals in flea treatments, irritating ingredients in grooming products, stress, or low-quality commercial dog food. Excessive yeast creates problems as it secretes enzymes and toxins which stress the immune system, overload the liver, and deposit in body tissues.

Yeast and the Immune system

When a vet sees a dog with allergies they may prescribe steroids to shut off the immune response, but while this will improve the symptoms it will not fix the underlying cause of the allergies. When your dog’s immune system is turned off with drugs, it can’t regulate and balance normal flora levels and yeast blooms may occur. If there are a secondary skin infection (caused by bacteria entering the skin through the dogs excessive scratching) antibiotics may be prescribed which are known to obliterate good bacteria along with the bad, wiping out healthy yeast levels and thus making the situation worse. So dogs with an underactive immune system or that are immuno-suppressed can end up with a yeast infection, as well as those dogs that have overactive immune systems or allergies.

Symptoms of an external yeast infection

Symptoms of this type of fungal infection are easy to spot and include
– Constant chewing or licking of the paws, or scooting their behind on the floor.
– Musty, pungent smelling paws or ears
– Dark rusty coloured hair between toes and the nail beds, and a rust colour around the genitals.
– Scratching the ears or head shaking, (a vet must rule out ear mites)
– Foul smelling greasy hair called seborrhea caused by a yeast infection of the hair follicle, which may be accompanied by dandruff.
– Hair loss on the tail and upper back.
– Black dots on the underbelly, or black patches of skin.
– Recurring secondary bacterial infections.
– Fatigue and joint pain may also be present.

Diagnosing a yeast infection

Yeast infections are often misdiagnosed. Some vets may prescribe steroids, antihistamines or antibiotics to treat a yeast infection. However, it can be easily determined if a yeast infection is present by taking skin scraping or rubbing a moistened Q-tip on the affected areas and viewing the sample cells under a microscope. Antibiotics don’t affect yeast so they keep on multiplying and making more yeast, which in turn, puts out more toxins and weakens the immune system.

Treating a yeast infection

The first step in successful treatment is to identify the cause of the infection and remove it as long term treatment of fungal infections is most successful when the cause is found and eliminated.

Feeding a nutritious diet is essential to eradicate yeast. Put your dog on a species appropriate diet avoiding low-grade commercial dog foods. Avoid carbohydrates and sugars in grains and fruit, including potatoes and rice as these ingredients will feed yeast and encourage overgrowth. Sugar is a major contributor to yeast infections so feed a low glycaemic diet.

Cleanse the yeasty parts of a dogs body. Yeast likes damp dark moist areas such as the armpits, genitals, in between paw pads, and groin creases. Yeasty ears should be gently cleansed regularly with a natural solution. To sooth itchy paws dipping the paws in a foot soak is more effective than wiping with a damp cloth. When washing does not use oatmeal based shampoo or grooming products as oats is a grain that provides a food source for the yeast. After bathing use a natural anti-fungal post bath rinses like the one below to prevent itching; this should be poured over the dogs body avoiding the face, head, and the ears,

Natural anti fungal post bath body rinse: mix 1 gallon of water with 1 cup of organic apple cider vinegar and pour over the dogs body after bathing. Do not pour on head, face, or ears; only use from the neck back towards the tail and over the legs, rub in the rinse and then pat the dog dry without rinsing out.

Stress affects dogs and humans, in the same way, it creates an internal environment that is supportive of imbalances. Things that cause stress in a dog include lack of exercise, kenneling, visits to the vet, visits to the groomers, home renovations, stress in the household from a death, divorce or job loss, or loud noises such as fireworks or thunder. To manage or reduce stress ensure your dog has daily exercise, a comfy place to relax and sleep, regular grooming with a groomer who they enjoy visiting, the regular expression of your love and affection, limited time in kennels, and try to make their visit to the vet a fun experience. Massage and aromatherapy can be used to support stress reducing practices.

Try to limit synthetic prescription medicines as they confuse the immune system and suppress your dog’s natural healing abilities. Antibiotics encourage yeast infections as do steroids. Flea and tick medications can stress a dog’s immune system and contribute to yeast problems.

All of this can be confusing when you are trying to the right thing for your pet. Speak with a holistic vet who can offer advice on what options are available using a natural health approach. Note: stopping some medications abruptly can have serious side effects. Consult your veterinarian before making any changes to your dog’s medication plan.

Taking these steps can help you provide your dog with a healthy and yeast resisting lifestyle.

Tinea incognita | DermNet NZ

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. 2003. Updated by Dr Jannet Gomez, November 2017.

What is tinea incognita?

Tinea incognita is the name given to a fungal skin infection when the clinical appearance has been altered by inappropriate treatment, usually a topical steroid cream. The result is that the original infection slowly extends.

Often the patient and/or their doctor believe they have a dermatitis, hence the use of a topical steroid cream. The steroid cream dampens down inflammation so the condition feels less irritable. But when the cream is stopped for a few days the itch gets worse, so the steroid cream is promptly used again. The more steroid applied, the more extensive the fungal infection becomes and the less recognisable.

Tinea incognita is often incorrectly spelled as tinea incognito. It is also known as steroid-modified tinea. 

Tinea incognita

What causes tinea incognita?

Tinea incognita is due to dermatophyte fungal infection (tinea), most often when it affecting the trunk and/or limbs (tinea corporis).  Trichophyton rubrum is the most common organism to cause tinea corporis and tinea incognita in New Zealand. 

Anti-inflammatory creams that can induce tinea incognita include:

Tinea incognita can also be caused by systemic steroids.

Underlying diseases may predispose individuals to infection, especially:

Factors such as sweating, abrasion, and maceration also contribute to the development of infection.

What are the clinical features of tinea incognita?

DermNet’s page on tinea corporis describes its usual clinical features. Compared with an untreated tinea corporis, tinea incognita:

  • Has a less raised margin,
  • Is less scaly,
  • More pustular,
  • More extensive,
  • And more irritable.

There may also be secondary changes caused by long term use of a topical steroid such as:

  • Atrophy (thin skin, stretch marks (striae) in the skin folds).
  • Purpura (bruising) and telangiectasia (broken blood vessels).

How is tinea incognita diagnosed?

The diagnosis of tinea is most easily made by taking skin scrapings for microscopy and culture a few days after stopping all creams.

  • If there is little surface scale, the laboratory may report the specimen to be inadequate or negative.
  • After stopping a steroid cream, tinea incognita becomes very inflamed and more fungal elements may be seen on microscopy than usual. 
  • The responsible organism generally grows promptly in culture.

If a skin biopsy is performed, the pathology of tinea incognita reveals the organisms. 

What is the treatment of tinea incognita?

Tinea is usually treated with topical antifungals (such as miconazole, ketoconazole, econazole), but if the treatment is unsuccessful, oral antifungal medicines may be considered, including terbinafine and itraconazole.

How can tinea incognita be avoided?

Tinea incognita can be avoided if:

  • Patients do not use topical steroids to treat undiagnosed skin conditions 
  • Medical practitioners consider the diagnosis of dermatophyte infection in any scaly or pustular rash that has a prominent and irregular border, and is unilateral or asymmetrical in distribution
  • Mycology is performed when in doubt about the diagnosis of a scaly or pustular rash.



  • Siddaiah N, Erickson Q, Miller G, Elston DM. Tacrolimus-induced tinea incognito. Cutis. 2004 Apr;73(4):237-8. PubMed PMID: 15134322. PubMed.
  • Navarrete‐Dechent C, et al. Rapid diagnosis of tinea incognito using handheld reflectance confocal microscopy: a paradigm shift in dermatology? Mycoses 58.6 (2015): 383-386.
  • Solomon B A, Glass AT, Rabbin PA. Tinea incognito and over-the-counter potent topical steroids. Cutis 58.4 (1996): 295-296.
  • Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J. 2016 Mar-Apr;7(2):77-86. doi: 10.4103/2229-5178.178099. Review. PubMed PMID: 27057486; PubMed Central PMCID: PMC4804599. 

On DermNet NZ

Books about the skin

See the DermNet NZ bookstore.

%PDF-1.4 %
249 0 obj > endobj xref
249 113
0000000016 00000 n
0000003219 00000 n
0000003378 00000 n
0000005100 00000 n
0000005127 00000 n
0000005280 00000 n
0000005630 00000 n
0000005891 00000 n
0000006400 00000 n
0000006642 00000 n
0000007153 00000 n
0000007406 00000 n
0000007457 00000 n
0000007508 00000 n
0000007558 00000 n
0000007609 00000 n
0000007660 00000 n
0000007711 00000 n
0000007762 00000 n
0000007813 00000 n
0000007927 00000 n
0000016030 00000 n
0000023603 00000 n
0000031181 00000 n
0000031293 00000 n
0000031433 00000 n
0000031839 00000 n
0000032095 00000 n
0000032702 00000 n
0000032949 00000 n
0000032976 00000 n
0000033477 00000 n
0000033608 00000 n
0000033994 00000 n
0000034580 00000 n
0000034979 00000 n
0000035290 00000 n
0000035317 00000 n
0000043278 00000 n
0000050505 00000 n
0000058845 00000 n
0000065952 00000 n
0000074325 00000 n
0000074508 00000 n
0000086356 00000 n
0000086603 00000 n
0000089413 00000 n
0000096835 00000 n
0000096921 00000 n
0000096991 00000 n
0000109947 00000 n
0000110335 00000 n
0000110596 00000 n
0000119567 00000 n
0000128691 00000 n
0000128793 00000 n
0000128863 00000 n
0000128932 00000 n
0000129301 00000 n
0000129594 00000 n
0000129829 00000 n
0000130328 00000 n
0000130771 00000 n
0000131170 00000 n
0000131647 00000 n
0000132134 00000 n
0000133922 00000 n
0000134254 00000 n
0000134649 00000 n
0000143773 00000 n
0000143812 00000 n
0000180589 00000 n
0000180628 00000 n
0000191228 00000 n
0000218716 00000 n
0000235072 00000 n
0000244902 00000 n
0000254385 00000 n
0000263918 00000 n
0000275409 00000 n
0000288642 00000 n
0000291367 00000 n
0000292625 00000 n
0000293967 00000 n
0000294970 00000 n
0000295950 00000 n
0000296928 00000 n
0000297907 00000 n
0000299955 00000 n
0000301611 00000 n
0000302688 00000 n
0000303796 00000 n
0000305019 00000 n
0000305496 00000 n
0000306790 00000 n
0000308034 00000 n
0000308992 00000 n
0000309977 00000 n
0000311715 00000 n
0000312922 00000 n
0000313452 00000 n
0000314415 00000 n
0000315378 00000 n
0000316414 00000 n
0000319729 00000 n
0000320810 00000 n
0000321341 00000 n
0000321941 00000 n
0000322448 00000 n
0000323801 00000 n
0000324948 00000 n
0000003039 00000 n
0000002556 00000 n
trailer ]/Prev 399112/XRefStm 3039>> startxref 0 %%EOF 361 0 obj >stream
hb““g`g` ̀

Antifungals, Vaginal, Antifungals, Systemic, Corticosteroids, Estrogens, Estrogen Receptor Antagonists


Jill M Krapf, MD, FACOG Assistant Professor, Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences; Assistant Director, Obstetrics and Gynecology Clerkship, Center for Sexual Health, Women’s Services

Jill M Krapf, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, American Congress of Obstetricians and Gynecologists, International Society for the Study of Women’s Sexual Health

Disclosure: Nothing to disclose.

Specialty Editor Board

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.


Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David S Howes, MD Professor of Medicine and Pediatrics, Emergency Medicine Residency Program Director Emeritus, Head, Phemister Society, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Reza Keshavarz, MD, MPH Clinical Assistant Professor, Departments of Pediatrics and Emergency Medicine, Mount Sinai School of Medicine; Director of Pediatric Emergency Medicine, Mount Sinai Hospital

Disclosure: Nothing to disclose.

Mark J Leber, MD, MPH Assistant Professor of Emergency Medicine in Clinical Medicine, Weill Cornell Medical College; Attending Physician, Lincoln Medical and Mental Health Center

Mark J Leber, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and American College of Physicians

Disclosure: Nothing to disclose.

Deslyn M Mancini, MD Instructor, Department of Obstetrics and Gynecology, MCP Hahnemann University

Bruce A Meyer, MD, MBA Executive Vice President for Health System Affairs, Executive Director, Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School

Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Omnia M Samra-Latif, MD Clinical Faculty, Department of Obstetrics and Gynecology, Robert Wood Johnson University, Hamilton Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Anuritha Tirumani, MD Research Coordinator, Department of Emergency Medicine, Brooklyn Hospital Center

Disclosure: Nothing to disclose.

Ellen Wood, DO, FACOOG Voluntary Assistant Professor, University of Miami, Leonard M Miller School of Medicine

Disclosure: Nothing to disclose.

Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

90,000 Malassezium Dermatitis in Dogs: Symptoms and Treatment

Malassezia is a type of small (5-7 microns) yeast that normally lives on the skin, including the ear canals, of humans and most animals and is one of the components of the natural skin defense. These fungi are not contagious, unlike the fungi that cause lichen, and the dog does not need to be isolated when diagnosed with malasseous dermatitis. Usually, the host’s organism is calm about Malassezia. He knows how much of this fungus should be on the skin, how to regulate its amount.However, some predisposing factors and various skin diseases can disrupt the natural balance, subsequently leading to an increase in the amount of malassezia on the skin. That is, malassezium dermatitis is always a secondary symptom that occurs in response to a violation of the skin microenvironment due to some underlying skin disease. Perhaps that is why malassezium dermatitis is quite common in adult and elderly dogs, which are more prone to developing a variety of primary skin diseases compared to young animals.Also, dogs have a breed predisposition to this dermatitis. It often occurs in West Highland White Terriers, Basset Hounds, Cocker Spaniels, Dachshunds, Poodles and German Shepherds.

Possible causes of malassezium dermatitis:

Malassezia dermatitis can develop against the background of such diseases as atopic (according to some studies, this is one of the most common symptoms of atopic dermatitis ) and flea allergic dermatitis , endocrine disorders, in particular hypothyroidism, Cushing’s syndrome (primary or caused by the use of hormones) , parasitic diseases, primarily demodicosis, as well as with primary or secondary seborrhea (a disease associated with increased secretion of the sebaceous glands and skin peeling). All of these diseases lead to disruption of the normal functioning of the skin barrier. Yeast fungi begin to multiply more actively on the skin, releasing substances that further destroy the protective layer and accelerate the process of normal desquamation of skin cells. In addition, the normal cohabitants of the skin – bacteria – also increase their numbers during fungal overgrowth (the proliferation of fungi beyond normal). These changes cause itching and irritation over time. A so-called vicious circle can often develop, where a large number of fungi cause inflammation, and the inflammation in turn stimulates the growth of fungi.

Also, in the absence of signs of an active underlying disease, increased moisture in various areas of the skin (often interdigital spaces and ear canals), increased production of sebum and / or sulfur, pronounced folding of the skin of the dog’s face or body can predispose to an increase in the amount of yeast on the skin … At the same time, exacerbations of malassezia dermatitis often occur in spring and autumn, since damp weather also contributes to the active growth of yeast fungi.

The clinical picture of malasseous dermatitis:

Malassezia dermatitis in dogs is manifested by local (one area of ​​the body may suffer) or generalized (extensive foci, localized in several areas of the body) skin lesions, accompanied by severe itching. Typical areas for malassezium dermatitis in dogs are the skin of the groin, armpits, interdigital spaces, ear canals, muzzle and tail folds. It can also affect the skin of the lower surface of the neck, around the lips, perianal (around the anus) and perivulvar (around the genitals in females) areas.

At the onset of the disease, erythema (redness), papular rash (small pimples without purulent contents) appear on the skin, the hair in these places can acquire a rusty hue. In this case, the dog, experiencing intense itching, tries to scratch with its paw, lick or rub the altered part of the body on objects, thereby injuring it. Crusts, scratches appear on the sore spot, the hair falls out and an unpleasant greasy coating with a characteristic rancid odor appears on the skin. With a prolonged course of malassezium dermatitis without treatment, the skin in the affected areas lichenified (thickens, loses elasticity and acquires a mosaic pattern) and hyperpigmented (acquires an intense gray-black coloration).

The defeat of the ear canals also causes itching, due to which the dog shakes his head, scratches his ears. The skin of the auricles becomes intense red and may swell. A large amount of brown ointment appears on the folds of the shell. The skin of the auricles can also become lichenified and hyperpigmented over time.

Canine malasseous dermatitis photo

Making a diagnosis:

Malassezia dermatitis is diagnosed on the basis of history data (age of onset of symptoms, breed), clinical examination (taking into account the number and appearance of the affected areas), diagnostic tests and response to trial treatment.

As a diagnostic test to detect an increased number of Malassezia fungi, fingerprints are used from the affected skin and the external auditory canal, which the doctor can examine during the appointment. By assessing the amount of yeast in the preparations and comparing this with the appearance of the lesions, the veterinary dermatologist can draw conclusions about whether the yeast is the cause of the inflammation.

It is important to remember that lesions in atopic allergic dermatitis, parasitic dermatoses (sarcoptosis and demodicosis ) and various keratinization disorders (keratinization of epidermal cells) may have a similar appearance, but the number of yeast fungi may not be increased.Therefore, self-administration of antifungal drugs to a dog without a visit to the doctor may be unreasonable.


When diagnosed with malassezium dermatitis in dogs, treatment includes external (shampoos, ointments, solutions) and systemic agents (tablets). In most cases, when the underlying cause is identified and the course of malassezia dermatitis is not started, external agents are sufficient for treatment.

Small lesions of the skin are lubricated with antifungal ointments with 1-2% ketoconazole, 2% miconazole, 2% climbazole or terbinafine 1-2 times a day. It is also possible to use a 2-4% chlorhexidine solution or a mixture of table vinegar and water in a ratio of 1: 3 or 1: 4 as a local antifungal agent (vinegar acidifies the medium and prevents fungi from developing). The affected skin can also be treated with 2% lime sulfuric solution and 0.2% enilconazole solution.

For malassezium otitis media in dogs, various drops with antifungal components are used.

If the area of ​​the lesions is large, then the dog is bathed 2 times a week with an antifungal shampoo, keeping it on the skin for up to 10 minutes.

The need to prescribe systemic antifungal drugs (tablets) remains at the discretion of the attending physician.

Since malassezium dermatitis in dogs is accompanied by active itching, it can be treated with antipruritic drugs. For this, a drug such as Apoquel is suitable. Earlier in the arsenal of a veterinarian to relieve itching and inflammation of the skin were only hormonal drugs (antihistamines are very weak for itching in dogs and cats), but their use was associated with a high risk of side effects. Apoquel allows in a short time (after already an average of 4 hours after taking the drug) to reduce the symptoms of itching and skin inflammation in the dog. In addition, Apoquel is well tolerated with long-term use, easy to dose and non-addictive. This drug can be combined with external and systemic antifungal agents, which can accelerate the disappearance of the symptoms of malassezia dermatitis.

The duration of treatment for malasseous dermatitis depends on each specific case.Thus, lesions of a small area with a known underlying disease can improve within 1-2 weeks with treatment. With extensive lesions and / or unknown primary disease, treatment can last from three weeks or more. In addition, in more complex cases, the risk of recurrent (re) development of malassezia dermatitis is higher. The dynamics of malassezium dermatitis must be assessed by a veterinarian every three to four weeks against the background of treatment by examination and control smears-prints from the lesions. After the disappearance of all symptoms, local and systemic therapy is extended for another two weeks, and then canceled.

It is important to remember that when diagnosed with malassezium dermatitis in dogs, treatment can be simple and easy with early veterinary attention. It is possible to prevent recurrence of malassezia dermatitis if it was possible to find out its cause (this may take time and additional research) and take it under control.

Take care of yourself and your pets.

90,000 Aspergillosis Antifungals – Aspergillosis Patient and Caregiver Support from NHS National Aspergillosis Center, UK

Treatment of fungal infections can be broadly described with three classes of antifungal agents. Echinocandins, azoles and polyenes.


Amphotericin B is often used intravenously to treat systemic fungal infections.It works by binding to a component of the fungal cell wall called ergosterol. Amphotericin B is probably the broadest range of intravenous antifungal agents. It has activity against Aspergillus, Blastomyces, Candida (all species, except for some isolates of Candida krusei and Candida lusitania), coccidioids, cryptococci, histoplasm, paracoccidioids and most pathogens of zygomycosis (mucous membranes), Fusarium and other rare fungi.It is not active enough against Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., Most species causing mycetoma and systemic infections caused by Sporothrix schenkii. Acquired resistance to amphotericin B has been described in selected isolates, usually after prolonged therapy in the context of endocarditis, but rarely. Amphotericin B can cause many side effects, which in some cases can be very serious.

Amphotericin can also be dosed through a nebulizer. Watch the video here.


Echinocandins are often used to treat systemic fungal infections in immunocompromised patients – these drugs inhibit the synthesis of glucan, which is a specific component of the fungal cell wall. These include micafungin, caspofungin, and anidulafungin. Echinocandins are best administered intravenously due to poor absorption.

Caspofungin is very active against all Aspergillus species.It does not completely kill Aspergillus in vitro. The activity against Coccidioides immitis, Blastomyces dermatitidis, Scedosporium varieties, Paecilomyces varioti and Histoplasma capsulata is very limited, but it is likely that this activity is insufficient for clinical use.


Itraconazole, fluconazole, voriconazole and posaconazole – the mechanism of action of itraconazole is the same as for other antifungal azoles: it inhibits the cytochrome P450 fungus-mediated oxidase synthesis of ergosterol.

Fluconazole is active against most Candida species, with the exception of absolute Candida krusei and partial exclusion of Candida glabrata, as well as a small number of isolates of Candida albicans, Candida tropicalis, Candida parapsilosis and other rare species. It is also active against the vast majority of Cryptococcus neoformans isolates. It is active against many other yeasts including Trichosporon beigelii, Rhodotorula rubra and dimorphic endemic fungi including Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatumand Paracoccidioides brasiliensis.It is less active than itraconazole against these dimorphic fungi. It is not active against Aspergillus or Mucorales. It is active against skin fungi such as Trichophyton.

Increased resistance has been reported in Candida albicans in AIDS patients. Typical resistance rates in Candida albicans in a general hospital are 3-6%, in Candida albicans in AIDS 10-15%, in Candida krusei 100%, in Candida glabrata ~ 50-70%, in Candida tropicalis 10-30% and in other Candida species are smaller.than 5%.

Itraconazole is one of the most widely available broad-spectrum antifungal agents and includes activity against Aspergillus, Blastomyces Candida (all species, including many fluconazole-resistant isolates), coccidioids, cryptococcus, histoplasm, paracoccidioids, Scedosporium apothiospermum, and It is also active against all skin fungi. It is not active against Mucorales or Fusarium and some other rare fungi. It is the best remedy for black mold including Bipolaris, Exserohilum, etc.E. Resistance to itraconazole has been reported in Candida, although less frequently than in fluconazole, and also in Aspergillus.

Voriconazole has an extremely wide range. It is active against the vast majority of Candida species, Cryptococcus neoformans, all Aspergillus species, Scedosporium agiospermum, some Fusarium isolates and many rather rare pathogens. It is not active against Mucorales species such as Mucor spp, Rhizopus spp, Rhizomucor spp, Absidia spp and others. Voriconazole has become invaluable in the treatment of invasive aspergillosis.

Posaconazole has an extremely broad spectrum of action. Fungi whose growth is inhibited by posaconazole include Aspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, various Mucorales species (causing zygomites), and numerous other black molds such as Bipolaris and Exserohilum. Most Aspergillus isolates are killed by posaconazole at clinically relevant concentrations. Acquired resistance to posaconazole occurs in Aspergillus fumigatus and Candida albicans, but is otherwise rare.

The side effects of azole drugs are well characterized, and there are also some important drug interactions that preclude the use of concurrent administration of certain drugs. For a more complete understanding of these issues, see the separate Patient Information Leaflet (PIL) for each drug (at the bottom of the page).


Some of the antifungals (eg itraconazole ) are taken by mouth and can be difficult to absorb, especially if you are on anti-acid medication (a medicine used to treat indigestion, stomach ulcers, or heartburn).This is because some stomach acid is required to dissolve the capsules and ensure absorption.

In case itraconazole Standard advice is to ensure that there is enough acid in the stomach by taking an effervescent drink such as cola along with medication (the carbon dioxide that causes the fizz also makes the drink acidic enough). Some people don’t like carbonated drinks, so substitute fruit juice for example. Orange juice.

Itraconazole capsules are taken after meal and 2 hours before taking antacids. Itraconazole solution is taken one hour before a meal as it is more easily absorbed.

It’s Worth Reading Patient Information Brochure are packed with your medicine as it gives you all the information you need to store and use it. At the bottom of this page, we provide a list of the most common drugs and links to their respective PILs.

Even after following all manufacturer’s instructions, absorption of some drugs is unpredictable. You may find that your doctor will take blood samples to check how well your body is absorbing antifungal drugs.

Side effects

All medicines have side effects (“side effects”) and drug manufacturers must list them on the Patient Information Sheet (PIL). Most of them are minor, but they are all worth mentioning with your doctor on your next visit.Side effects can be very varied and often completely unexpected. If you are not feeling well, it is always worth checking the list of side effects on PIL, as there may be a problem with the medication you are taking. If in doubt, always consult your doctor.

Steroids are especially prone to causing many unpleasant side effects. There is information that pertains to steroid side effects and how best to take steroids Here is .

Patients experiencing side effects are given a number of tips – perhaps persistence in taking the drug leads to the disappearance of the problem, or the patient can be stopped from taking the drug. A different medication will be prescribed from time to time to counteract the side effect.

With the exception of the most severe cases, the patient is not recommended to stop taking the drug without consulting a doctor.

There are many drug interactions that many people must take, which can cause serious side effects.Check the interactions between antifungal drugs and any other medications you may be taking by searching our Antifungal Interactions Database.

Voriconazole and squamous cell carcinoma: A 2019 review of 3,710 people who received lung or hematopoietic cell transplants found a significant association between voriconazole use and squamous cell carcinoma in these patients. Longer duration and higher doses of voriconazole have been associated with an increased risk of SCC.The study confirms the need for regular dermatological surveillance of patients with RT and NBT on voriconazole, and suggests that alternative therapies should be adopted, especially if the patient is already at increased risk of SCC. The authors note that the data have been rather limited and further research is needed to further explore this relationship. Read the article here.

Report on drug side effects:

UNITED KINGDOM: In the UK, the MHRA has a Yellow Card Scheme where you can report the side effects and side effects of drugs, vaccines, complementary therapies and medical devices.There is a simple online form to fill out – you don’t need to do it through your doctor. If you need help with the form, reach out to someone at NAC or ask someone on the Facebook support team.

US: In the US, you can report side effects directly to the FDA through their MedWatch Scheme.

Antifungal availability :

Unfortunately, not all antifungal drugs are available in every country in the world, and even if they are, the price can vary significantly from country to country.The Global Fund for Action on Fungal Infections (GAFFI) has released a set of maps showing the availability of major antifungal drugs worldwide.

Click here to view antifungal availability map GAFFI

Further information

The most common drugs prescribed for long-term use in people with aspergillosis are listed below with details. There is also a list of simplified information for most of these drugs Here is .

It is worth reading the Patient Information Leaflet (PIL) about the drug you are about to start taking and note any warnings, side effects, and list of incompatible drugs. It’s also a great place to read specific instructions on how to take your medications. We supply the most recent copies below:

(PIL – Patient Information Brochure)

  • Steroids:
  • Antifungal:
    • Amphotericin
      • Abelcet ( PIL )
      • ambiz ( PIL )
      • Fungizone ( PIL )
    • Anidulafungin (ECALTA)
      • Solution 100 mg ( PIL )
    • Caspofungin (CANCIDAS)
    • Fluconazole (Diflucan)
    • Flucytosine (Ancotil) ( PIL )
    • Itraconazole (Sporanox)
      • Pulse ( PIL )
      • capsule ( PIL )
      • IV ( PIL )
      • Solution ( PIL )
    • Micafungin (Mikamine)
    • Posaconazole (Noxafil)
      • Tablet 100 mg ( PIL )
      • 300 mg IV ( PIL )
      • 40 mg oral ( PIL )
    • Voriconazole (VFEND)
      • 200 mg powder ( PIL )
      • 40 mg / ml oral ( PIL )
      • 50 and 200 mg tablets ( PIL )
    • Isavuconazole
      • 100 mg Hard Capsules ( PIL )
      • 200ml Powder ( PIL )
  • Side effects – seePIL & VIPIL flyers listed above, plus full reports from the EU. MRHA Yellow Card Reporting System here
  • 90 230 90 000 what you need to know about their interaction

    18 September 2018

    Medicines and micronutrients: what you need to know about their interactions.

    Micronutrients (vitamins and minerals) and medicines use the same pathways for absorption, movement through the body, and excretion.When we take medications, there is always the possibility of interactions that will upset the balance of nutrients. Micronutrients, in turn, can alter the effect of drugs.

    An imbalance of vitamins and minerals causes serious metabolic disorders, because micronutrients are involved in all physiological processes. The drugs will not disturb the balance of vitamins and minerals if they are taken in a short course by an adherent of proper nutrition with a sufficient level of micronutrients in the body.But what if your nutrient intake isn’t enough? Or has the drug been taken for a long time? In these cases, the interaction between micronutrients and drugs becomes relevant and must be taken into account. In this case, the duration of treatment and the content of micronutrients in the body before the start of treatment are of primary importance.

    Brief overview of the interactions of common drugs and micronutrients

    Painkillers and anti-inflammatory drugs

    Acetylsalicylic acid reduces absorption and accelerates the excretion of vitamin C.And the combined use of aspirin and iron increases the irritating effect on the stomach. Diclofenac, ibuprofen, indomethacin with vitamin E work as synergists. Synergy is when 2 + 2 = 5, not 4. The analgesic and anti-inflammatory effects are enhanced, lower doses of the drug are needed and side effects occur less frequently.


    Frequent use of antacids – drugs for heartburn – based on aluminum and magnesium causes deficiencies in zinc, iron, vitamins A and B1.Medicines to reduce the production of hydrochloric acid in the stomach (omeprazole, rabeprazole and other “prazoles”) prevent the absorption of vitamin B12, which can lead to anemia. Laxatives such as bisacodyl reduce the amount of potassium in the body.

    Cardiovascular drugs

    Drugs with the ending “-pril” (enalapril, captopril and others), as well as “sartans”, such as losartan, are capable of retaining potassium, which is dangerous for heart rhythm disturbances.But the amount of zinc in the body decreases with their use. Bisoprolol, metoprolol and other beta-blockers reduce coenzyme Q10 levels.

    Remedies for high cholesterol

    Statins reduce vitamin D and coenzyme Q10 stores, while cholestyramine interferes with the absorption of all fat-soluble vitamins (A, D, E, and K), vitamin B12, folate and calcium.


    Furosemide and hydrochlorothiazide remove many trace elements from the body: potassium, calcium, magnesium, zinc.In contrast, spironolactone is capable of retaining potassium, which is why it is called a potassium-sparing diuretic.


    Levomycetin reduces the level of vitamin B12, because it interferes with its absorption. The antibiotic doxycycline works much weaker when taken at the same time as calcium, magnesium, iron, or zinc. An interval of at least two hours must be observed. Doxycycline accelerates the excretion of vitamin C from the body, so the reserves of ascorbic acid must be replenished.

    Antidiabetic agents a

    The antihyperglycemic tablets and insulin are more effective when used in conjunction with alpha lipoic acid. But against the background of treatment with metformin, vitamin B12 and folic acid are poorly absorbed.

    Hormonal preparations

    Combined contraceptives cause deficiencies in vitamin B6, magnesium and folic acid. Glucocorticoids prednisone and dexamethasone remove vitamins A, C, folic acid and potassium from the body.