What is candidal intertrigo. How does it develop in skin folds. What are the main symptoms and risk factors. How is candidal intertrigo diagnosed and treated. What preventive measures can help avoid recurrence.

Understanding Candidal Intertrigo: A Common Yeast Infection of the Skin Folds

Candidal intertrigo is a superficial fungal infection that occurs in warm, moist areas of skin folds. It is caused by overgrowth of Candida yeast, most commonly Candida albicans. This condition frequently affects areas like the armpits, under the breasts, in the groin, and between fingers or toes.

The hot, humid environment of skin folds provides ideal conditions for yeast proliferation. When combined with friction between skin surfaces, this can lead to inflammation, redness, and breakdown of the skin barrier – allowing Candida to invade and cause infection.

Key Risk Factors for Developing Candidal Intertrigo

Several factors can increase a person’s susceptibility to candidal intertrigo:

• Obesity – excess skin folds provide more areas for infection
• Diabetes – elevated blood sugar promotes yeast growth
• Hyperhidrosis (excessive sweating)
• Incontinence – prolonged skin exposure to moisture
• Immunosuppression – weakened ability to fight infections
• Tight, occlusive clothing
• Hot, humid weather
• Poor hygiene

Understanding these risk factors is crucial for both prevention and management of recurrent infections. Addressing modifiable factors like maintaining good hygiene and wearing breathable fabrics can significantly reduce one’s risk.

Recognizing the Signs and Symptoms of Candidal Intertrigo

Identifying candidal intertrigo early is key to prompt treatment. Common symptoms include:

• Redness and inflammation in skin fold areas
• Itching, burning, or stinging sensations
• Moist, glistening appearance of affected skin
• Scaling or flaking of the skin
• Small red papules or pustules (satellite lesions) at the edges of the rash
• Cracking or fissuring of the skin in severe cases

Is the appearance of satellite lesions specific to candidal infections? Yes, the presence of small red bumps or pustules at the periphery of the main rash is a characteristic sign of candidal intertrigo. This feature helps distinguish it from other skin fold rashes.

Diagnosis and Differential Considerations

While the clinical presentation is often suggestive, definitively diagnosing candidal intertrigo may require additional steps:

1. Physical examination – assessing the appearance and distribution of the rash
2. Potassium hydroxide (KOH) preparation – microscopic examination of skin scrapings to identify yeast cells
3. Fungal culture – to confirm Candida species and guide treatment
4. Wood’s lamp examination – some Candida species fluoresce under UV light

Differential diagnoses to consider include:

• Bacterial intertrigo
• Inverse psoriasis
• Seborrheic dermatitis
• Tinea infections (dermatophytes)
• Erythrasma

Accurate diagnosis is crucial for appropriate treatment, as these conditions may require different therapeutic approaches.

Effective Treatment Strategies for Candidal Intertrigo

Managing candidal intertrigo involves a multi-faceted approach:

1. Topical Antifungal Medications

First-line treatment typically includes topical antifungal agents such as:

• Azoles (e.g., clotrimazole, miconazole, ketoconazole)
• Nystatin
• Terbinafine

These medications are applied directly to affected areas, usually twice daily for 2-4 weeks.

2. Keeping the Area Dry

Moisture control is crucial for treatment success and prevention of recurrence. Methods include:

• Thoroughly drying skin folds after bathing
• Using absorbent powders (e.g., zinc oxide, talc-free options)
• Wearing moisture-wicking fabrics

3. Reducing Inflammation

In cases with significant inflammation, short-term use of low-potency topical corticosteroids may be beneficial. However, these should be used cautiously and under medical supervision, as prolonged use can exacerbate fungal infections.

4. Oral Antifungal Therapy

For severe or recalcitrant cases, oral antifungal medications like fluconazole may be prescribed. These are typically reserved for widespread infections or when topical treatments have failed.

How long does it typically take for candidal intertrigo to respond to treatment? Most cases show significant improvement within 1-2 weeks of starting appropriate therapy. However, complete resolution may take up to 4 weeks, and it’s important to continue treatment as directed to prevent recurrence.

Preventing Recurrence: Long-term Management Strategies

Preventing recurrent episodes of candidal intertrigo is essential for long-term skin health. Key strategies include:

• Maintaining good hygiene practices
• Keeping skin folds dry and well-ventilated
• Wearing loose-fitting, breathable clothing
• Managing underlying conditions like diabetes or obesity
• Using preventive antifungal powders or creams in prone areas
• Avoiding prolonged antibiotic use when possible

For individuals with frequent recurrences, intermittent use of topical antifungals or regular application of barrier creams may be recommended.

Special Considerations: Candidal Intertrigo in Infants and the Elderly

Certain populations may require modified approaches to managing candidal intertrigo:

Infants

Diaper rash is a common form of candidal intertrigo in babies. Management includes:

• Frequent diaper changes
• Gentle cleansing and thorough drying
• Use of barrier creams or ointments
• Topical antifungals as prescribed

Elderly Individuals

Older adults may be more susceptible due to factors like:

• Reduced mobility
• Incontinence
• Weakened immune systems

Care should focus on maintaining skin integrity, managing underlying conditions, and prompt treatment of infections.

When to Seek Medical Attention for Candidal Intertrigo

While mild cases of candidal intertrigo can often be managed with over-the-counter treatments, certain situations warrant professional medical evaluation:

• Persistent or worsening symptoms despite self-treatment
• Widespread or severe rash
• Signs of secondary bacterial infection (increased redness, warmth, swelling, or pus)
• Frequent recurrences
• Underlying health conditions that may complicate treatment

A healthcare provider can offer a definitive diagnosis, rule out other conditions, and provide appropriate treatment recommendations.

Can candidal intertrigo lead to more serious complications if left untreated? While generally confined to the skin surface, untreated candidal intertrigo can potentially lead to more extensive skin breakdown, secondary bacterial infections, or rarely, systemic candidiasis in severely immunocompromised individuals. This underscores the importance of timely and appropriate treatment.

The Role of Diet and Probiotics in Managing Candidal Infections

While the direct impact on candidal intertrigo is less clear, some evidence suggests that dietary modifications and probiotic supplementation may help support overall resistance to Candida overgrowth:

Dietary Considerations

• Reducing sugar and refined carbohydrate intake
• Increasing consumption of fermented foods
• Ensuring adequate protein and healthy fats in the diet

Probiotics

Certain probiotic strains, particularly Lactobacillus species, may help maintain a healthy balance of microorganisms on the skin and mucous membranes. While more research is needed, some studies suggest that both oral and topical probiotics could play a role in preventing and managing candidal infections.

It’s important to note that dietary changes and probiotic use should be viewed as complementary strategies rather than replacements for standard antifungal treatments in active infections.

Emerging Research and Future Directions in Candidal Intertrigo Management

Ongoing research continues to explore new approaches to preventing and treating candidal intertrigo:

• Novel antifungal agents with improved efficacy and reduced resistance potential
• Development of probiotic formulations specifically targeted for skin health
• Investigation of natural compounds with antifungal properties
• Advancements in moisture-wicking and antimicrobial fabrics

These areas of study hold promise for enhancing our ability to manage candidal intertrigo more effectively in the future.

As our understanding of the skin microbiome grows, how might this impact future approaches to preventing and treating candidal intertrigo? Emerging research on the complex ecosystem of microorganisms on our skin may lead to more targeted therapies that aim to restore and maintain a healthy balance of skin flora, potentially reducing the risk of Candida overgrowth and infection.

In conclusion, candidal intertrigo is a common but manageable condition that affects many individuals, particularly those with specific risk factors. By understanding its causes, recognizing its symptoms, and implementing appropriate treatment and prevention strategies, most cases can be effectively controlled. As research continues to advance, we can look forward to even more refined and personalized approaches to managing this challenging skin condition.

Yeast Diaper Rash (Candidiasis) | TPG Pediatrics

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What is diaper rash?

Red and irritated skin in the diaper area. There are many causes. The most common are fungal, irritant contact, and seborrheic dermatitis.

• Fungal diaper rash is caused by a yeast called Candida albicans. It can happen naturally, or commonly during or after a course of antibiotics.

• Irritant contact dermatitis is caused by skin rubbing against a wet, soiled diaper.

• Seborrheic dermatitis does not have a clear cause but may also be due to a fungus called Malassezia.

What are the signs or symptoms?

• Redness in the diaper area.

• Fungal

  • Rash is worse in the skinfolds (creases) within the diaper area.

  • Redness often bordered by red pimples (“satellite lesions”).

  • Rash may have a shiny appearance.

  • Sores or cracking or oozing skin present in severe cases.

• Irritant contact

  • The rash spares the creases and emphasizes areas in contact with the diaper (inner thighs, genital areas, and buttocks)

  • Absence of satellite lesions

• Seborrheic

  • Red, greasy scales in diaper area. May also be located on scalp, face, ears, and neck.

What are the incubation and contagious periods?

• Incubation period for fungal diaper rash: Unknown.

• Contagious period: The yeast that infects the diaper area is widespread in the environment, normally lives on the skin, and is found in the mouth and stool. Candida diaper rash may occur with or following antibiotic use. Repetitive or severe Candida diaper rash could signal immune problems.

How is it spread?

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2.

• Candidal (yeast) diaper rash: Treat with an antifungal cream so the quantity of yeast in any area is reduced to levels the body can control.

• Contact/irritant diaper dermatitis: Keep the skin dry and reduce irritation through friction from rubbing of a diaper or other clothing. Avoid soaps or wipes that contain fragrance. Frequent diaper changes, air exposure, or avoiding rubbing of material against the involved skin may help.

• Seborrhea: Treatment with antifungal cream or shampoo may help.

What are the roles of the teacher/caregiver and the family?

• Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of ill children. That person, in turn, alerts the parents/guardians so they can seek treatment for the child.

• Administer prescribed medication as instructed by the child’s health professional.

Exclude from group setting?

No.

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

© 2020 American Academy of Pediatrics. All rights reserved.

AAP Feed run on 6/28/2023 8:21:20 AM.
Article information last modified on 1/24/2022 6:59:28 AM.

Candidal Intertrigo — DermNet

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2003.  Update: Dr Thomas Stewart, General Practitioner, Sydney, Australia, November 2017.

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What is candidal intertrigo?

Candidal intertrigo refers to superficial skin-fold infection caused by the yeast, candida.

Candida intertrigo

Axillary candidosis

Submammary candidosis

Erosio-interdigitalis blastomycetica

See more images of candida intertrigo.

What causes candidal intertrigo?

Candidal intertrigo is triggered by a combination of the following factors:

• The hot and damp environment of skin folds, which is conducive to the growth of candida species, particularly Candida albicans 
• Increased skin friction
• Immunocompromise.

Who gets candidal intertrigo?

Factors that increase an individual’s risk of developing candidal intertrigo include:

• Occlusive clothing, gloves and footwear
• Obesity
• Excessive sweating (hyperhidrosis)
• Incontinence causing irritant contact dermatitis (incontinence-associated dermatitis)
• Diabetes mellitus
• Immune deficiency conditions, such as human immunodeficiency virus infection (HIV) or immune suppression by medications (chemotherapy, systemic corticosteroids).

What are the clinical features of candidal intertrigo?

Candidal intertrigo classically presents as erythematous and macerated plaques with peripheral scaling. There are often associated superficial satellite papules or pustules.

Affected areas may include: 

• Skin folds below the breasts or under the abdomen
• Armpits and groin
• Web spaces between the fingers or toes (erosio-interdigitalis blastomycetica).  

How is candidal intertrigo diagnosed?

Diagnosis of candidal intertrigo requires recognition of consistent clinical features. In cases of uncertainty, confirmation can be sought by way of fungal microscopy and culture of skin swabs and scrapings. Skin biopsy is usually not necessary.

What is the differential diagnosis for candidal intertrigo?

Other forms of intertrigo should be considered, including:

• Tinea cruris (groin) and athlete’s foot (between toes)
• Contact dermatitis
• Atopic dermatitis
• Seborrhoeic dermatitis
• Flexural psoriasis
• Impetigo
• Extramammary Paget disease
• Herpes simplex
• Hailey Hailey disease.

How is candidal intertrigo treated?

• Predisposing factors should be addressed primarily, such as weight loss, blood glucose control, and avoidance of tight clothing.
• Patients should be advised to maintain cool and moisture-free skin. This may be aided by regular use of a drying agent such as talcum powder, especially if infection is recurrent.
• Topical antifungal agents such as clotrimazole cream are recommended as first-line pharmacological treatments.
• Severe, generalised and/or refractory cases may require oral antifungal treatments such as fluconazole or itraconazole.

References

1. Yaar M, Gilchrest BA. Aging of skin. In: Fitzpatrick’s Dermatology in General Medicine, Freedberg IM, Eisen AZ, Wolff K, et al (Eds), McGraw-Hill, New York 2003. p.1386
2. Garcia Hidalgo L. Dermatologic complications of obesity. Am J Clin Dermatol. 2002;3(7):497. PubMed.
3. Jautova J, Baloghova J, Dorko E, et al. Cutaneous candiosis in immunosuppressed patients. Folia Microbiol. 2001;46(4):359. Journal full text  PDF file
4. Ingordo V, Naldi L, Fracchiolla S. Prevalence and risk factors for superficial fungal infections among italian navy cadets. Dermatol.2004;209(3):190-6. PubMed.
5. Klenk AS, Martin AG, Heffernan MP. Yeast infections: candidiasis, pityriasis (tinea) versicolor. In: Dermatology in General Medicine, Freedberg IM, Eisen AZ, Wolff K, et al (Eds), McGraw-Hill, New York 2003. p.2006.
6. Sobera JO, Elewski BE. Fungal Diseases. In: Dermatology, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Mosby, London 2003. p.1171.
7. Guitart J, Woodley DT. Intertrigo: a practical approach. Compr Ther. 1994;20(7):402. PubMed.
8. Runeman B. Skin interaction with absorbent hygiene products. Clin Dermatol. 2008;26(1):45. PubMed.
9. Gray M. Optimal management of incontinence-associated dermatitis in the elderly. Am J Clin Dermatol. 2010;11(3):201. PubMed.
10. Hay RJ. The management of superficial candidiasis. J Am Acad Dermatol. 1999;40(6 Pt 2):s35. PubMed.
11. Metin A, Dilek N, Demireseven DD. Fungal infections of the folds (intertriginous areas). Clin Dermatol. 2015;33(4):437–47. PubMed.
12. 12. Karla MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014.89(1):569–73. PubMed.

On DermNet

• Candida
• Images of candida intertrigo 
• Introduction to fungal infections
• Laboratory tests for fungal infections
• Treatment of fungal infections
• Napkin dermatitis

Other websites

• Cutaneous candidiasis — Medscape Reference

Books about skin diseases

• Books about the skin
• Dermatology Made Easy book

What does a fungal infection look like on a dog’s skin?

In the early stages of a yeast infection, the skin begins to turn pink or red. In chronic yeast infections, the skin can become leathery, thick, gray, or black. Oily skin. The skin may become oily or overly oily.

Superficial candidal skin infections appear as a red, flat rash with sharp, jagged edges. Small areas of a similar-looking rash known as “satellite lesions” or “satellite pustules” are usually found nearby. These rashes may be hot, itchy, or painful. Intertrigo looks like softened red skin in areas of body folds.

After diagnosing a yeast infection, your veterinarian will prescribe an antifungal medicine. It may include ointments such as miconazole, which are applied to the infected area. Your veterinarian may also suggest using a special antifungal shampoo to help relieve symptoms.

If only a small area is involved, it is probably not necessary to bathe the entire animal. To cleanse the affected area, you can use special wipes with acetic acid. Mixtures of vinegar and water (50:50) can be used, but the pet will have a distinct smell of vinegar.

Answer: Some of the most effective natural topical remedies that can be used to treat a mild Candida skin infection include apple cider vinegar, coconut oil, garlic, and tea tree oil. They are inexpensive, easy to use, and have minimal side effects.

The fastest way to get rid of a yeast infection is to see a doctor and get a prescription for fluconazole. OTC monistat (miconazole) and prophylaxis may also help.

A mild yeast infection can go away on its own, but this is rare. It’s always a good idea to treat a yeast infection, even if it’s mild. If yeast infections are not properly treated, they are more likely to return. Treatment for a yeast infection soothes the affected area and targets the overgrown Candida.

Common causes of yeast infection in dogs may include: Allergies. The most common cause of a yeast infection in dogs is an allergy to fleas, food, or substances in the environment. Allergies can irritate the skin and make the skin more oily. Some dogs can also develop an allergic reaction to yeast.

Bathe weekly with a natural anti-fungal shampoo if yeast appears on the armpits and other parts of the body. DO NOT USE OATMEAL on a yeast dog. Oatmeal is a grain that is a source of nutrition for yeast. After you have completely rinsed with water, rinse again with an antifungal agent.

Carbohydrates are complex chains made up of sugar molecules. Therefore, when your pet consumes carbs, they are broken down into sugar, which feeds the yeast. Therefore, avoid dog foods containing millet, oats, rice, peas, corn, wheat, and potatoes.

It can take up to six weeks for the infection to clear up. Your veterinarian may recommend a complete cleaning of your dog’s ear canal. If the problem is chronic, ask about special cleansers and ear dryers that you can use at home.

Probiotic yogurts are safe for both dogs and humans and can help with your gut health. Probiotics can help fight yeast infections in dogs that can cause skin and ear problems, boost immunity, and help your dog’s body absorb nutrients. … In general, natural yogurt is best, and probiotic yogurt is better instead.

Classification of mycoses

Surface
mycoses (keratomycosis)
– cause keratomycetes, slightly contagious
fungi that infect the stratum corneum of the epidermis
and hair surface .

Dermatomycosis
(epidermophytosis)
-caused by dermatophytes or
dermatomycetes. Have septate
mycelium with arthroconidia, chlamydospores,
macro- and microconidia. Resistant to
drying and freezing. Trichophytons
remain in the hair up to 4-7 years. Are dying
at 100′ in 10-20 minutes. Sensitive to
the action of UV, alkali solutions,
formaldehyde, iodine. pathogens
transmitted through contact with a sick person
person or animal or through contact
with various environmental objects
environment, for example, through household items
(combs, towels), as well as in baths,
showers, swimming pools. Allocate anthropo-,
zoo, geophilic dermatophytes. pathogens
live on keratinized substrates
(keratinophilic fungi). development
diseases contribute to minor
skin lesions, maceration, weakened
immunity, increased sweating,
endocrine disorders and long-term
application of AB. Dermatophytes do not penetrate
beyond the basement membrane of the epidermis.
The skin is affected to varying degrees
hair and nails. affected by mushrooms
hair breaks off, develops
focal alopecia, baldness. Leather
flaky, vesicles, pustules appear,
cracks. Itching of lesions develops.
Inflammation is absent or may be
in expressed form. With fungal
nail infections – onychomycosis
(T.rubrum, T.interdigitale) change color,
transparency, thickness, surface,
strength and integrity of the nail
plates.

L.:

• With dermatophytosis
  scalp – fluconazole,
  itraconazole, griseofulvin.

• With dermophytosis
  nails carry out systemic (griseofulvin,
  lamisil, nizoral, diflucan) and topical
  antifungal therapy.

• With dermatophytosis
  stop applying antifungal creams
  and ointments (lamisil, nizoral, mycospor) in
  combined when indicated with systemic
  therapy and antihistamines.

Subcutaneous (subcutaneous) mycoses
– pathogens
found in soil, wood or
dying, decaying plants. Infiltrating
in places of skin microtraumas (damages
splinter, thorn), they involve in the process
deep layers of the dermis, subcutaneous tissues,
muscles and fascia.

Systemic pathogens (deep)
mycoses

Exciters
opportunistic mycoses
– conditionally pathogenic fungi of the genera
Aspergillus, Mucor, Penicillium, Fusarium, Candida (+ pathogens
pneumocystis pneumonia conditionally pathogenic
yeast-like pneumocystis fungi
Pneumocystis carinii) – They cause diseases
in persons with transplants, against the background of reduced
immunity, irrational long
AB therapy, hormone therapy, use
invasive research methods.
Found in soil, water, air,
rotting plants; are included in the n.m.f.
(for example, fungi of the genus Candida).

Main
pathogens of nosocomial infections
— C.albicans ,
Aspergillus
spp. ,
Fusarium spp., Trichosporon spp., Malassezia spp.

Exciters
candidiasis (genus Candida)
cause superficial, invasive
and other forms of candidiasis (candidomycosis).

TO
the most important pathogenic species
include C. albicans, C.glabrata, C.crusei, C.parapsilosis,
C.lusitaniae.

Matt. and Fl.:
Mushrooms of the genus Candida consist of oval
budding yeast cells (4-8 microns),
pseudohyphae and septate hyphae. C.albicans
form chlamydospores
– thick-walled double-circuit large
oval spores. On simple nutrients
media at 22-27′ form yeast
pseudohyphae cells. in Candida tissue
grow in the form of yeast and pseudohyphae.

candida
are part of the n.m.f. person. Can
invade tissue (endogenous infection)
and cause candidiasis in patients with
weakened immune defenses. At
sexual transmission may develop
urogenital candidiasis. More often candidiasis
called C.albicans, which produces
protease
and integrin-like molecules for adhesion
and other virulence factors.

candida
can cause visceral candidiasis
various organs, systemic candidiasis,
superficial mucosal candidiasis
membranes, skin and nails, chronic
(granulomatous) candidiasis, allergy
for AG Candida.

Express D.:
IF method and other serological tests
used to detect antigens
exciter in the material.

L:

[Material for
research: plaque from mucous membranes
membranes, skin scales from the focus
lesions, sputum, urine, CSF, blood and
others]

• Microscopic
  – in preparations stained according to the method
  Gram, Romanovsky-Giemsa, native
  preparations – unicellular are visible
  microorganisms round or oval
  forms.

• Mycological
  – inoculation on Sabouraud agar, incubated at
  20′ and 37′. Colony growth starts at 2-3
  day, final formation
  colonies on day 5-6 (colonies are convex,
  shiny, creamy, opaque
  with different shades). Identification
  fungi of the genus Candida are carried out on the basis of
  cell morphology, type of filamentation
  and biochemical properties. candida
  uroinfection is established with
  detection of more than 10^5 colonies of Candida spp.