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

3 Symptoms, Diagnosis, and Management of Candida

*This course has been retired.

There is no replacement course at this time. Please click here to view the current ATrain course listings.

Clinical Symptoms

The clinical symptoms vary depending on the location affected by the yeast. From head to toe, the most common sites for fungal infections include the scalp, skin, mouth, gastrointestinal tract, genitourinary tract, vagina, and nail beds of the hands and feet. The most dangerous type of fungal infection is an invasive infection (or systemic infection) that enters the bloodstream; it is called candidemia.  Fungal infections that originate in the oral cavity and extend into the esophagus have a higher potential to become an invasive infection because they become systemic.

Classically, yeast infections look red, warm, sometimes scaly, and continue to spread if not treated. They can be itchy but not generally painful unless directly on the skin of the genitals and buttocks. They generally do not cause a fever but if not treated can cause a sense of malaise and gastrointestinal upset and bloating if in the GI tract. To review the specific symptoms, let’s look at each of them based on locations of the body.

Skin Infections

Topical skin infections include the scalp, head, face, back, chest, axilla, under the breast or in other skin folds, and anywhere on the body from head to toe. When a yeast infection develops on the skin it generally appears red, scaly and inflamed with symptoms of itching and burning, however unique configurations can occur that help diagnose the yeast. An example is the classic shape of a ringworm infection on the skin, called Tinea corporis. Ringworm is misnamed because there is no actual worm on the skin, rather the unique shape caused by the dermatophyte yeast. Superficial skin infections by yeast at the epidermis are caused by fungi called dermatophytes.

Internal Infections

Because yeast is very common as topical normal flora, skin infections can easily develop given the right environment. Additionally, the moist and warm internal environment of the body offers ideal growth for candida.

Vaginal Candidiasis

Speculum exam in candidal vulvovaginitis, showing thick, curd-like plaque on the anterior vaginal wall. A slightly erythematous base is visible close to the center of the image, where some of the plaque was scraped off. Mikael Häggström. Source: Wikimedia Commons. Creative Commons CC0 1.0 Universal Public Domain Dedication.

From head to toe, internal candida infections commonly occur in the mouth, known as oral thrush. It appears as a white sticky coating and can even appear hairy from the extensions of hyphae. It can be easily treated with an oral antifungal, such as a swish and swallow medication. Good oral hygiene for patients on ventilators and rinsing after taking an inhaled glucocorticoid can help prevent this.

Gastrointestinal yeast infections often present as GI bloating, nausea, vomiting, diarrhea and generalized malaise. In diets high in sugar, the GI yeast can easily grow and contribute to belly fat, constipation, poor metabolism of food, and further infection (García-Elorriaga & Rey-Pineda, 2013).

A very common internal yeast infection occurs in the vagina. Symptoms include vaginal itching, foul fishy odor, and white cottage-cheese–like discharge. Upon visualization using a speculum, it is easy to diagnose because of its white discharge. It can be cultured for definitive diagnosis, however, most clinicians will easily recognize it and treat it with antifungals intravaginally, or orally.

Skin yeast infections can also appear as a red, flat rash with scalloped edges. Satellite lesions are extensions of the original yeast that grow to extend the rash. As noted above, tinea infections are identified by their location on the body.

Diagnosing Candida

KOH Test on a Candida Specimen

KOH test on a vaginal wet mount showing slings of pseudohyphae of Candida albicans surrounded by vaginal epithelial cells conferring a diagnosis of candidal vulvovaginitis. Mikael Häggström. Source: Wikimedia Commons. Creative Commons CC0 1.0 Universal Public Domain Dedication.

Often a candida infection is easily identifiable but a definitive diagnosis can only be done via a microscope or culturing. A skin scraping or swab sampling can be placed under a microscope, which reveals the typical and classic hyphae or fern-like growths. A single drop of potassium hydroxide, KOH, is often added to the microscopic slide, which dissolves the human skin cell wall and exposes the yeast and identifiable hyphae.

When using the culture method, a simple sterile swab of the infected surface is wiped on the culture medium (e.g., a blood agar petri dish) and allowed to grow in an incubated temperature of 98.6ºF for several days. Yeast and bacterial colonies easily occur within 3 to 5 days. Because candida is part of the normal flora, identifying a true infection is based on the various candida species that may grow in an agar culture, the agar fermentation, and assimilation tests.

Agar Plate Culture of C. Albicans

Source: CDC Public Health Image Library. Public domain.

Clinicians can often recognize a yeast infection based on its location and classic morphology and do not order diagnostic tests but treat right away. For example, when a practitioner sees the classic ring worm formation a topical antifungal is ordered. Occasionally a clinician may observe the skin directly with an ultraviolet light known as a Wood’s lamp. The spores of the yeast become fluorescent with a Wood’s lamp and appear blue-green when exposed to ultraviolet light.

For invasive agents within the bloodstream, non-culture candida detection tests can be done with antigen testing such as the Beta-D-Glucan, or candida PCR, which detects candidal DNA. Candida heat-liable-antigen assays—D-arabinitol assay or D-inositol assay—can also be used based on the laboratory’s preference and equipment. Immunological tests such as skin tests can also be performed.

Treatment of Yeast

Prompt treatment is key to quick destruction of out of control yeast.

Pharmacological treatment of candida depends on the location. The severity of the fungal infection also dictates the type of antifungal to be used for treatment. An acute fungal infection on the skin can often easily be treated with topical antifungals, however if they have become extensive or chronic, often long-term topical agents in addition to oral agents need to be prescribed.

For most acute fungal skin infections, topical antifungals commonly used include:

• Clotrimazole (Lotrimin, Mycelex)
• Ketoconazole (Xolegel)
• Miconazole (aloe vesta antifungal, azolen, baza antifungal, carrington antifungal, critic aid clear, cruex prescription strength, dermafungal, desenex, fungoid tincture, micaderm, micatin, micro-guard, miranel, mitrazol, podactin, remedy antifungal, secura antifungal)
• Terbinafine (Lamisil)

Prescription topical agents for resistant or extensive infections may include:

• Ciclopirox (Loprox, Penlac)
• Ketoconazole (Nizoral)
• Oxiconazole (Oxistat)

Administration of these antifungals are generally via a cream that is applied twice daily for 2 to 4 weeks. The length of application depends of course on the severity of the yeast and if the infection is acute or chronic. A topical ringworm infection may require treatment for 14 days, however a topical great-toenail fungal infection may require months of treatment and be very difficult to get rid of as the yeast have become embedded in the matrix of the nail.

For chronic yeast infections, an oral antifungal should be given and may include (Jaliman, 2019):

• Fluconazole (Diflucan)
• Griseofulvin (Fulvicin P/G, Fulvicin U/F, Grifulvin V, Gris-Peg): oral and spray. May need 8-10 weeks for effect. Cannot take during pregnancy or breastfeeding. May cause birth defects. Men should use condoms for up to six months after treatment to prevent birth defects.
• Itraconazole (Sporanox): 1-2 weeks. Not for use in elderly and children with liver disease.
• Ketoconazole (Nizoral)
• Terbinafine (Lamisil): once daily x 4 weeks

All oral antifungals are processed by the liver’s first-pass effect, which may cause nausea, diarrhea, indigestion, headache, dizziness, and even rashes. These oral antifungals are contraindicated for those with liver disease and lupus.

For severe fungal infections that impact a mechanical device, prescription IV antibiotics that are used include:

• Amphotericin
• Azole antifungals
• Echinocandins such as micafungin

Removal of the mechanic device or tube should also be a priority to avoid entry of the pathogen into the bloodstream.

Alternative medicines and folk medicine have been used to treat yeast infections. Although not endorsed by the American Medical Association, patients may be using these remedies and healthcare professionals should be aware of them. Many studies exist demonstrating the effectiveness of various essential oils(e.g., oregano oil) and even food substances (Alves-Silva, 2013). Studies have even shown effectiveness of apple cider vinegar against topical and intestinal yeasts.

Back Next

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.