About all

Yeast infection skin folds treatment: The request could not be satisfied

Содержание

Recurrent candidal intertrigo: challenges and solutions

Clin Cosmet Investig Dermatol. 2018; 11: 175–185.

Ahmet Metin

1Department of Dermatology and Venereology, Medical School of Ankara, Yildirim Beyazit University, Ankara, Turkey

Nursel Dilek

2Department of Dermatology and Venereology, Medical School of Recep, Tayyip Erdoğan University, Rize, Turkey

Serap Gunes Bilgili

3Department of Dermatology and Venereology, Medical School of Yuzuncu, Yil University, Van, Turkey

1Department of Dermatology and Venereology, Medical School of Ankara, Yildirim Beyazit University, Ankara, Turkey

2Department of Dermatology and Venereology, Medical School of Recep, Tayyip Erdoğan University, Rize, Turkey

3Department of Dermatology and Venereology, Medical School of Yuzuncu, Yil University, Van, Turkey

Correspondence: Ahmet Metin Ankara, Ataturk Egitim ve Arastirma Hastanesi, Deri ve Zuhrevi Hastaliklar Kliniği, Üniversiteler Mahallesi, Bilkent Caddesi No:1, Çankaya, Ankara, Turkey, Tel +90 312 291 2525, ext 3154, Email moc. [email protected] © 2018 Metin et al. This work is published and licensed by Dove Medical Press LimitedThe full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.This article has been cited by other articles in PMC.

Abstract

Intertrigo is a common inflammatory dermatosis of opposing skin surfaces that can be caused by a variety of infectious agents, most notably candida, under the effect of mechanical and environmental factors. Symptoms such as pain and itching significantly decrease quality of life, leading to high morbidity. A multitude of predisposing factors, particularly obesity, diabetes mellitus, and immunosuppressive conditions facilitate both the occurrence and recurrence of the disease. The diagnosis of candidal intertrigo is usually based on clinical appearance. However, a range of laboratory studies from simple tests to advanced methods can be carried out to confirm the diagnosis. Such tests are especially useful in treatment-resistant or recurrent cases for establishing a differential diagnosis. The first and key step of management is identification and correction of predisposing factors. Patients should be encouraged to lose weight, followed up properly after endocrinologic treatment and intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases. Medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals. In this context, it is also possible to use magistral remedies safely and effectively. In case of predisposing immunosuppressive conditions or generalized infections, novel systemic agents with higher potency may be required.

Keywords: Candida, intertrigo, recurrent candidal intertrigo, candidiasis, candidosis, candidal predisposals

Background

Intertrigo (intertriginous dermatitis) is a clinical inflammatory condition that develops in opposing skin surfaces in response to friction, humidity, maceration, or reduced air circulation. 1 This common skin disorder may be localized in a small area or involve larger surfaces. Lesions mostly develop in the neck, axilla, sub-mammary fold, and perineum, while other sites may also be involved including antecubital, umbilical, perianal, and interdigital areas as well as abdominal folds, eyelids, and the retroauricular area.13

The main factor in the development of the lesions is the mechanical friction on the skin that initially appears as a minimal erythema of the folds. Heat, reduced aeration, humidity, and maceration facilitate intertrigo. Although the condition may occur in both genders and all races, it is more common in diabetic obese individuals residing in hot and humid climates and in bed-ridden or elderly subjects. Urinary or fecal incontinence, inadequate personal hygiene, malnutrition, immunosuppression, and occlusive clothing are among other predisposing factors. Infants are also more likely to develop intertrigo due to drooling and short neck structure with prominent skin folds and a flexed position. 2 Many yeasts (particularly Candida) and molds, bacteria, and viral infectious agents may aggravate intertrigo by colonizing on the skin ().

Table 1

Infectious agents commonly found in intertrigo

Microorganisms Species References
Candida C. albicans, C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, C. dubliniensis, C. famata 4–11
Fusarium F. oxysporum, F. solani 12–18
Dermatophytes Trichophyton spp. , Microsporum spp., and Epidermophyton floccosum 2,8,9,15,19,20
Malassezia Mostly M. furfur, M. globosa or M. sympodialis 9,21–23
Bacteria S. aureus, S. agalactiae, S. haemolyticus, S. pyogenes, or other streptococcal species Pseudomonas spp., Proteus spp., E. coli, Peptostreptococcus spp., Corynebacterium spp., Acinetobacter spp., etc. 2,11,24–26
Viruses Poxviridae, Papillomaviridea (HPVs), Picornaviridae, Retroviridae (HIV), Herpesvirdae, Togaviridae, Parvoviridae, 27–30

Intertrigo may transform into a life-long chronic condition. It generally has an insidious onset with symptoms such as itching, pain, burning, or prickling sensations in skin fold areas.7 Initially it presents itself as mildly erythematous papillae or plaques, quickly developing into an exudative erosion, fissures, macerations, and crusts. Erythema due to secondary infections, increased inflammation, papullo-pustules, and bad odor may develop.1,2,7

Diagnosis of intertrigo and its complications are generally based on clinical manifestations and basic microbiological investigations. Microbiological cultures, potassium hydroxide (KOH) preparation, and Gram’s staining may guide the therapy when used for differentiating primary and secondary infections. Wood’s light examination can be used to identify a Pseudomonas, Malassezia, or erythrasma infection more quickly than would a culture. Despite the absence of a characteristic histopathological appearance, biopsy may be required in treatment-resistant cases of intertrigo in order to exclude other skin disorders such as psoriasis or lichen planus. 1,2

Treatment of intertrigo should generally focus on the removal of predisposing factors, followed by appropriate use of topical or systemic antimicrobial agents as well as low-potency corticosteroids, if required.

Candida species

Taxonomically, Candida belongs to the phylum Ascomycetes, class Blastomycetes, order Cryptococcales, family Cryptococcaceae, and genus Candida.31 These microorganisms have a diameter of 3–5 μm with a two-layered cell wall. Among more than 200 Candida species identified, only 15 may be associated with primary Candida infections.32 Yeasts associated with Candida species can be found in the normal flora of human skin as well as in the mucosal covering of the gastrointestinal system, genito-urinary system, and respiratory system, in addition to the soil and a variety of foods.31 Human colonization starts on the first day after birth and continues throughout the life-cycle as an opportunistic pathogen. Candida albicans is responsible for the majority of Candida-related noninvasive skin and mucosal candidiasis. However, a more than 50% increase in the incidence of non-albicans Candida species have recently been reported including C. glabrata, C. parapsilosis, C. tropicalis, C. krusei, C. lusitaniae, C. dubliniensis, and C. guilliermondii.33 Each of these organisms exhibits characteristic virulence potential, antifungal susceptibility, and epidemiology.34

Pathogenesis of candidal infection

C. albicans is a part of the normal flora in skin and genital and/or intestinal mucosa in 70% of healthy individuals.35 Similar to many other opportunistic microorganisms of the skin, it exists as a commensal yeast in individuals with an intact immune system. It may lead to mucocutaneous or systemic infections under appropriate conditions.

Many Candida species are known to produce virulence factors like proteases. Species lacking these virulence factors are considered less pathogenic.3639 Mechanisms of pathogenicity for Candida albicans may be summarized as below: secretion of hydrolases, molecules that mediate adhesion to with concomitant invasion into host cells, the yeast-to-hypha transition, biofilm formation, contact sensing and thigmotropism, phenotypic switching, and a variety of fitness attributes.37

As is the case with all pathogens, the innate immunity of the skin represents the first step of the host defense against Candida.40 Pathogenic invasion is a rather complex process and is initiated through disruption of the physical barrier by the transformation of Candida on the skin from yeast to hypha form. The capability of the yeasts to adhere to epithelium is a strong stimulant for the hyphal transformation and represents the most important step in tissue penetration.37,3941 Hyphae of C. albicans exhibit stronger epithelial adhesion than yeasts. More aggressive C. albicans species that have no ability to produce hyphae cannot attach to epithelium. Breakdown of the physical barrier with fungal invasion allows the spread of C. albicans to underlying vascular tissues, and then to distant organs. While transformation into the hypha form is a critical virulence factor both for epithelial penetration and phagocyte attachment of C. albicans, the yeast form is required for the development of systemic infection and dissemination.38,41

The contest between the host and Candida involves more specific and complex molecular mechanisms; the recognition of fungal cell wall components, activation of the immune cell signal pathways of the host, and release of cytokines and chemokines.41 Formation of hyphae by C. albicans is also known to represent a very important factor that induces cytokine responses from epithelial cells. 42 The importance of cytokine and chemokine production has been underlined almost universally in all studies investigating the epithelial responses to C. albicans. Infected epithelial cells have been found to produce IL-lα/β, IL-6, G-CSF, GM-CSF, and TNFα, in addition to chemokines and cytokines such as RANTES, IL-8, and CCL20.38,4345

An examination of the immune mechanisms of the skin against C. albicans reveals that the defense barrier initiated with the stromal cells such as keratinocytes and melanocytes as well as the defense proteins released by these cells continues with the pattern recognizing receptors such as Dectin-1 and Toll-like receptor. Individuals with mutations or gene polymorphisms in pathways of these receptors have been found to be more susceptible to Candida infections.46 The major mechanisms of innate immunity against candida infections include neuropeptides such as calcitonin gene-related peptide (CGRP) released in areas where the physical barrier is disrupted, IL-23 release from the dendritic cells, and activation of neutrophils recruited via IL-17 release from γδ T cells that is stimulated by the release of IL-23. On the other hand, IL-17 pathways represent an important component of the adaptive immunity against Candida infections through induction of effector and cytotoxic T lymphocytes.35

Predisposing factors for candidal infections

The main determinant of the non-pathogenic commensal colonization versus pathogenic behavior is the balance between fungal proliferation and the innate and adaptive defenses of the host.41 This balance is disturbed in favor of Candida as a result of various factors that predispose the individual to intertrigo ().

Table 2

Predisposing factors for Candida infections.

Factor group Factors
Dermatoses Psoriasis Contact dermatitis
Endocrine disease Diabetes mellitus Hypoadrenalism
Cushing disease Hypothyroidism
Hypoparathyroidism
Iatrogenic Catheters and intravenous lines Radiation therapy
Immunosuppressive agents Colchicine
Broad spectrum antibiotics Phenylbutazone
Estrogen containing oral contraceptives Tranquilizers
Glucocorticoids
Immunodeficiency HIV infection Chronic granulomatous disease
SCIDS Chediak-Higashi syndrome
Myeloperoxidase deficiency DiGeorge syndrome
Hyper IgE syndrome Nezelof syndrome
Neutropenia Other immunosuppressive diseases
Mechanical and environmental Trauma (burns, abrasions) Occlusive wearings
Occlusion, humidity, maceration Obesity
Dentures Tropical environment
Nutritional Vitamin deficiencies (B6, B12) Generalized malnutrition
Iron deficiency (CMC) High carbohydrate content
Physiological Extremes of age (infants, elderly) Pregnancy
Menses Low vaginal pH
Sialorrhea Debilitating
Systemic illnesses Down syndrome Uremia
Acrodermatitis enteropathica Sjögren syndrome
Other Uncircumcised penis Infected sexual partner
Poor hygiene Prolonged hospitalization
Prolonged exposure to water Finger sucking
Malignancies Smoking
Severe sweating Occupational factors

Clinical forms of candidal skin infection

C. albicans is responsible for approximately 80–90% of all skin infections caused by Candida species. It is an oval-shaped thermal dimorphic yeast with a diameter of 2–6 × 3–9 μm that can produce budding cells, pseudo-hyphae, and true hyphae. Skin infections encompass numerous forms with varying clinical terminology used to describe them. Although the clinical variants of skin infections have been clearly defined in the literature, currently no consensus regarding a standard classification system exists. In a 1996 classification by the American Academy of Dermatology’s Guidelines/Outcomes Committee,47 the infections have been defined on the basis of their location and appearance as follows: cutaneous (intertriginous agents), oral (intra-oral mucosa), genital (vagina and penis), nail unit, and chronic mucocutaneous. However, different clinical classification systems have been proposed in many dermatological or other textbooks, or reviews.31,4951,57,58,6265

Regardless of the size of the lesion, Candida infections involving skin folds should be classified under the candidal intertrigo heading, based on the definition intertriginous dermatitis ().

Table 3

Clinical presentations and locations of intertriginous candidal infections

Terminology Clinical presentation Location References
Intertriginous candidiasis (intertrigo) Erythema, maceration, hydration, crusting, fissuring, folliculitis, papules, pustules, satellite lesions, plaques, foul-smelling, itching, stinging Abdominal folds 7,9,11,32,33,51,62,63,66
Axilla and inguinal folds 2,7,9,11,47,51,54,60,62,63,66–75
Cervical or neck creases 2,7,9,32,41,45,51,60,62,63,71,73,76,77
Diaper areas 2,7,9,31,47,51,63,66,78–80
Finger or toe webs 2,7–9,12,26,47,48,51,61–63,76,81,82
Folds of the eyelids 2,9,51,63,83
Intergluteal area 2,7,9,67,84,85
Perianal 9,11,47,51,62,66,73,75,79,83
Perineum 31,51,62,70,75
Retroauricular folds 51,60,67,73,83
Submammary creases 9,11,66,72,86
Umbilicus 2,9,44,51,70

Candidal intertrigo

C. albicans has a predilection for moist and macerated skin folds. The most frequent type of clinical presentation in hairless skin is intertrigo. Pruritic, erythematous, macerated skin areas are observed in intertriginous areas with satellite vesicopustules. The characteristic pustulae rapidly rupture, leading to the formation of collaret type erythematous surface, from which the necrotic epidermis may be easily removed.9,87

Candidal intertrigo of larger skin folds usually involves the axilla, gluteal, infra-mammary, and genito-crural fold (). The moisture and increased temperature on the surface of opposing skin folds provide a suitable medium for the growth of Candida and bacteria. Humid and hot weather, tight underclothes, poor hygiene, and inflammatory skin conditions such as psoriasis may increase the risk of candidal infections.9 Diabetes mellitus and obesity represent the leading predisposing factor. Xerostomia, hyperhidrosis, occlusive wearings, occupational factors, use of corticosteroids or wide spectrum antibiotics, and immunosuppression including HIV infection may also increase the risk. 3,51,68,88,89

Candida intertrigo on the infra-mammary folds of a middle-aged woman.

Diaper candidiasis

Diaper dermatitis is an acute and inflammatory skin reaction in the diaper area (). It is generally caused by the yeast colonizing in the gastrointestinal system. Chronic occlusion with wet clothes facilitates the infection. With prevalence ranges between 7 and 35%, it most commonly occurs in infants between 9 and 12 months of age, and may also be seen in adults requiring incontinence pads.10 Infants with Candida diaper dermatitis generally have colonization in their gastrointestinal system with positive stool cultures for Candida. In infants with very low birth weight ≤ 1500 g, candidal colonization of the rectum and stools can be detected in 21–62.5%.90

Diaper candidial infection of a child.

Lesions typically start in the perianal region, and spread over the perineum and inguinal area. Not all cases of diaper dermatitis may be caused by Candida, but diaper dermatitis due to candidiasis involves the skin folds. Multiple small erythematous desquamated pustules and satellite lesions extending along the borders of large maculae represent significant findings for diagnosis.51,88,90

Granuloma gluteale infantum is a reaction developing Candida that causes opaque, reddish, irregular papules and/or nodules on the background of an erythematous surface in the diaper area. This is a reactive condition developing due to chronic irritant contact dermatitis caused by urinary incontinence or chronic diarrhea.63,89,91 Diagnosis is generally straightforward, and biopsy may be required to rule out mast cell tumors, pseudolymphoma, lymphoma, and leukemic infiltration.92

Angular cheilitis (perleche)

This condition is characterized by erythema, maceration, transverse fissures, and pain in the corners of the mouth. Although it is localized in the skin folds on the lips, it is classified within the group of oral candidal infections. Recurrent oral candidiasis is a common finding in HIV-infected subjects and is an important prognostic marker.78 In HIV-positive patients, it may occur without other signs when the CD4+ lymphocyte count declines below 200/μL.93 Frequently, it occurs due to use of lip liners in younger individuals, while skin sagging may be a causative factor in the elderly. Tooth loss, ill-fitting dental fixtures, and malocclusion represent other predisposing factors.78,88,89 It may occur concomitantly with submental and cervical intertrigo, particularly in infants and debilitated patients with salivary discharge.

Erosio interdigitalis blastomycetica

Candidal intertrigo settling between the fingers, also termed as erosio interdigitalis blastomycetica (EIB), is an infectious condition that may develop by a candidal or polymicrobial infection. It usually affects the third and fourth fingers or toes due to physical inactivity, moisture, soap, water retention, or disruption of the skin barrier. The moisture under a ring may cause maceration and irritation, facilitating secondary infections with C. albicans. Lesions may cause oval, macerated, whitish lesions that may extend to the lateral borders. Generally, one or more fissures with a reddish-base are present in the middle of the lesions. As the disease progresses the macerated skin is peeled off, leaving an eroded area in which the protruding epidermis is surrounded by a white collar.51 Microbiological cultures suggest that Candida and gram negative bacilli play a role in the development of this condition.94 Very often, it develops as an occupational disease due to chronic maceration in individuals with chronic contact with water such as cooks, barmen, barmaids, dishwasher, housewives, or dentists. Diabetes mellitus is a predisposing disease for EIB, and EIB is an important cutaneous manifestation of diabetes. 9,82 Thus, in patients diagnosed with EIB, a diagnosis of de novo or uncontrolled diabetes should be considered.81 The differential diagnosis includes erythrasma and irritant contact dermatitis.9,82

Toe web candidiasis

It is an EIB-like intertriginous Candida infection, commonly occurring in the fourth interdigital space of the toes. It may be asymptomatic or cause mild symptoms. Moist working conditions and use of tight and closed shoes for prolonged periods of time may induce this condition.2,51 The skin exhibits white, macerated, and thickened epidermis. Its appearance is very similar to that of tinea pedis, and significant erythema and desquamation may occur as well.2,51

Perianal, perineal and intergluteal candidosis

Perianal, perineal, and genitocrural areas are naturally moist areas of the skin.9 Intertrigo may develop as an extension of vulvovaginal or intestinal candidiasis or due to spreading from one area to another. 9,49,64 Initially, it may present as severe perineal and anal pruritus accompanied by severe itching and burning sensation. An erythematous, oozy dermatitis together with maceration is observed in involved areas (). Also satellite lesions in the form of papules or pustules may be observed in the margins of erythematous-macerated plaques and eroded areas.50,84 Absence of satellite lesions does not rule out a diagnosis of candidiasis.51

Perianal and intergluteal candidal intertrio of a man.

In cases where the cause of the condition is vulvovaginal or intestinal candidiasis, the disease may exhibit a recurrent and chronic course. Acute genitocrural intertrigo may also develop as a maculopapular eruption in HIV-infected subjects.2

Differential diagnosis of candidal intertrigo

Numerous infectious agents, mainly bacteria and dermatophytes, may lead to similar clinical presentations in the areas affected by Candida intertrigo in addition to a variety of mucocutaneous disorders that can mimic the inflammation in the lesions. Some of these conditions have been presented in according to the involved site in intertrigo.

Table 4

Most common differential diagnoses for intertriginous dermatitis on skin-fold areas

Differential diagnosis Anatomical sites of candidal infection


Large skin folds (axilla, inframammary, umbilical, intergluteal, and genitocrural) Diaper intertrigo EIB Toe web intertrigo Perianal and perineal intertrigo intertrigo of the neck folds Eyelids and retroauricular
Atopic dermatitis
Bacterial intertrigo
Bullous impetigo
Contact dermatitis
Dermatophyte infections
Drug interaction
Erythrasma
Extramammary Paget disease
Flexural Darier disease
Fusarium spp. infections
Glucagonoma
Granular parakeratosis
Hailey disease
Herpes infections
HPV infections
Langerhans cell histiocytosis
Leiner disease
Lichen planus inversus
Multiple carboxylase deficiency
Psoriasis
Seborrheic dermatitis
Syphilis
Verrucous carcinoma
Zinc deficiency/acrodermatitis enteropathica

Preventing recurrent infections

Preventive measures for recurrent intertrigo are used to support the therapy and represent the first step in management. The affected area(s) should be kept dry, clean, and cool with good airing and minimization of skin friction at the fold site. Good hygiene should be maintained in the infected area. Patients should be advised to wear cotton underwear, light clothing in hot and humid weather conditions, and should be warned regarding outdoor activities. Open shoes may help to prevent intertrigo of the toes.2,95

Maceration or irritation due to incontinence should be minimized or eliminated totally if possible. Cleansers, driers, emollients, and skin barrier creams may prove to be useful in such cases.7

Laboratory diagnosis of intertrigo

The clinical appearance of candidal intertrigo usually suffices for a diagnosis. However, laboratory investigations and confirmatory tests may be required, particularly in chronic, resistant, and recurrent cases.51 The simplest examination technique involves identification of the presence of pseudo-hyphae or yeast forms under direct microscopic examination of the samples obtained through scraping and smears that have been prepared with KOH and calcofluor white staining. Also, fluorescent microscopy and trypan blue examination may be used for that purpose. Differentiation between the species, assimilation and fermentation tests are applied on Candidal cultures.58 More advanced techniques rarely required in the clinical practice include PCR, electron microscopy, and microchip diagnostic tests. Biopsy may be performed for the differential diagnosis from psoriasis as well as from dermatoses and dermatophytoses such as tinea. Identification of septa-free hyphae and yeast forms in PAS-stained histopathological samples is diagnostic for Candida.

Treatment of candidal intertrigo

Specific treatment of candidal intertrigo depends on the location, severity, and depth of the infection. Also, the treatment may be guided by the stage of the infection, i.e. acute, subacute, or chronic.58 Initially, the active Candida infection should be medically managed, followed by skin drying measures to reduce the risk of recurrence, and finally by the correction of predisposing factors ().62,84

Topical anti-fungal agents are the mainstay of treatment in Candidal intertrigo. Topical anti-fungal agents represent the first step in management in mild cases of candidiasis. Nystatin and azole topical antifungals including miconazole, ketoconazole, or clotrimazole may be used twice daily for 2–4 weeks.84 Time-tested magistral preparations may also aid in treatment. In acute lesions, Domeboro® solution (Moberg Pharma North America LLC, Cedar Knolls, NJ, USA), Castellani paint (ICM Pharma, Singapore), or vinegar–water solutions may be applied twice daily for 5–10 minutes. After drying, a mixture of zinc oxide, talc, and glycerin may be administered twice daily. In subacute lesions, after cleansing with benzoyl peroxide, Castellani stain, or vinegar, topical antifungals may be administered. In chronic lesions, rinsing lotion containing zinc-talk applied twice daily may be beneficial. Also, night-time application of antifungal/corticosteroid combinations may be recommended.58 For itchy and painful lesions, an antifungal agent combined with corticosteroids (mostly hydrocortisone) may also be added to the treatment. In cases with local hyperhidrosis, anti-perspiration agents such as 20% aluminum chloride can be used in the long term. If maceration or moisture is present, astringent and antiperspirant solutions may be applied following antifungal creams.

In extensive, severe, and resistant intertrigo, systemic anti-fungal treatment is required. Oral fluconazole at a dose of 50–100 mg/day or itraconazole at a dose of 200 mg/day may be recommended for a total duration of 2–6 weeks until symptoms resolve. For pediatric cases, the recommended fluconazole and itraconazole doses are 6 mg/kg/day and 5–10 mg/kg/day, respectively.84

Diaper candidiasis

Diaper candidiasis can be generally managed with topical antifungal agents. Nystatin ointment or powder is commonly used, with a clinical cure rate of approximately 85%.90 Treatment with other azoles such as clotrimazole and miconazole may also give successful results. Despite similar mycological cure rates, miconazole is more effective than nystatin for symptomatic relief.79,80

For concomitant bacterial infections or irritation, combination of 1% hydrocortisone with antimicrobial agents such as sodium fusidate or clioquinole may be used. If recurrent diaper candidiasis is related to oral and intestinal colonization, addition of oral nystatin suspension may elicit a clinical response.51

Angular cheilitis (perleche)

Angular cheilitis (perleche), when secondary to a Candida infection of the oral mucosa, should be brushed regularly, together with twice daily administration of an antiseptic oral rinse solution such as chlorhexidine gluconate (0.12%, suspension) or Gentian violet 0.5% solution.59,104 Patients with xerostomia should be encouraged to increase water consumption, and sugar-free lozenges should be advised to increase salivation.59

Interdigital candidiasis (EIB and toe web candidiasis)

Special applicators may be recommended for drying the inter-toe spaces in interdigital candidiasis (EIB and toe web candidiasis).9 Also, triggering factors should be avoided. For treatment, topical antifungal agents (azole antifungals) are generally adequate. Good outcomes have been reported with filtering paper adsorbed with Castellani stain.51,105 In recurrent or resistant cases, systemic itraconazole, terbinafine, or amorolfine may be used.

Correction of predisposing factors

Obese patients should be encouraged to lose weight, and diabetes should be under good control.7,81 Patients with large and sagging breasts may benefit from breast reduction surgery.2,106 For excessive sweating between the breasts, sweat-absorbing towels may be utilized. If present, predisposing factors (malocclusion, teeth loss, etc.) should be corrected in patients with angular cheilitis. For anatomical problems, the depth of skin folds may be reduced by injection of cosmetic filling material.9 Topical or systemic administration of corticosteroids may also lead to chronic or recurrent candidiasis via immune suppression.47,62,78 Wide spectrum antibiotics may also lead to Candida colonization and pathogenicity by disrupting the saprophytic flora of the skin and mucosal membranes. A detailed history of medication should be obtained to avoid unnecessary use of antibiotics and corticosteroids.47,50,62,64,107 If high doses are involved, oral contraceptives with lower estrogen content should be preferred. For the recurrent intertrigo of the perianal area and its surroundings due to intestinal colonization, nystatin may be given.32 Nutritional deficiencies such as iron and B2 deficiency may facilitate mucocutaneous candidiasis.58,59,53 Patients wearing rings should be recommended to keep the skin under the ring dry and clean. Good aeration with open shoes may be recommended for toe web intertrigo. In cases with chronic incontinence, regular and absorbing hygienic products should be utilized for skin care.

Prognosis

Candidal intertrigo has a good prognosis in healthy immunocompetent individuals with no co-morbidites, and complete resolution of symptoms may be achieved with correct diagnosis and appropriate topical treatment. Ideally, in all cases with intertriginous candidiasis, all predisposing and provoking factors should be totally eliminated; if that is not possible, then these factors may be reduced. In more severe and recurrent cases of vaginal, oral, or chronic mucocutaneous candidiasis, systemic antifungals generally yield good results.

Footnotes

Disclosure

The authors report no conflicts of interest in this work.

References

2. Janniger CK, Schwartz RA, Szepietowski JC, Reich A. Intertrigo and common secondary skin infections. Am Fam Physician. 2005;72(5):833–838. [PubMed] [Google Scholar]3. Wolf R, Oumeish OY, Parish LC. Intertriginous eruption. Clin Dermatol. 2011;29(2):173–179. [PubMed] [Google Scholar]4. Beurey J, Weber M, Percebois G. Etude clinique et mycologique des intertrigos des pieds [Clinical and mycologic study of intertrigo of the feet] Phlebologie. 1969;22(1):73–79. French. [PubMed] [Google Scholar]5. Coldiron BM, Manders SM. Persistent Candida intertrigo treated with fluconazole. Arch Dermatol. 1991;127(2):165–166. [PubMed] [Google Scholar]6. de Andrade MF, Nishinari K, Puech-Leão P. Intertrigo em pacientes com linfedema de membro inferior. Correlacao clinico-laboratorial [Intertrigo in patients with lower limb lymphedema. Clinical and laboratory correlation] Rev Hosp Clin Fac Med Sao Paulo. 1998;53(1):3–5. Portuguese. [PubMed] [Google Scholar]7. Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014;89(7):569–573. [PubMed] [Google Scholar]8. Katoh T. Guidelines for diagnosis and treatment of mucocutaneous candidiasis. Nihon Ishinkin Gakkai zasshi [Jap J Med Mycol.] 2009;50(4):207–212. Japanese. [PubMed] [Google Scholar]9. Metin A, Dilek N, Demirseren DD. Fungal infections of the folds (intertriginous areas) Clin Dermatol. 2015;33(4):437–447. [PubMed] [Google Scholar]10. Tüzün Y, Wolf R, Bağlam S, Engin B. Diaper (napkin) dermatitis: a fold (intertriginous) dermatosis. Clin Dermatol. 2015;33(4):477–482. [PubMed] [Google Scholar]11. Veraldi S. Rapid relief of intertrigo-associated pruritus due to Candida albicans with isoconazole nitrate and diflucortolone valerate combination therapy. Mycoses. 2013;56(Suppl 1):41–43. [PubMed] [Google Scholar]12. Bahmaei M, Dehghan P, Kachuei R, Babaei H, Mohammadi R. Interdigital intertrigo due to Fusarium oxysporum. Curr Med Mycol. 2016;2(1):43–46. [PMC free article] [PubMed] [Google Scholar]13. Bissan AT, Iken M, Doumbia M, Ou-Khedda N, El Alaoui M, Lmimouni B. Fusarioses superficielles a Fusarium solani chez un immunocompetent et un immunodeprime diagnostiquees a l’Hopital militaire de Rabat [Fusarioses to Fusarium solani in an immunocompetent and immunocompromised diagnosed in military hospital of Rabat] J Mycol Med. 2017;27(3):382–386. French. [PubMed] [Google Scholar]14. Diongue K, Ndiaye M, Badiane AS, et al. Intertrigo interorteils a Fusarium solani a Dakar [Tinea pedis due to Fusarium solani in Dakar] J Mycol Med. 2015;25(2):155–158. French. [PubMed] [Google Scholar]15. Diongue K, Ndiaye M, Diallo MA, et al. Fungal interdigital tinea pedis in Dakar (Senegal) J Mycol Med. 2016;26(4):312–316. [PubMed] [Google Scholar]16. Néji S, Trabelsi H, Cheikhrouhou F, et al. Fusarioses diagnostiquees au laboratoire d’un CHU en Tunisie: etude epidemiologique, clinique et mycologique [Fusariosis diagnosed in the laboratory of an UH in Tunisia: epidemiological, clinical and mycological study] J Mycol Med. 2013;23(2):130–135. French.aw. [PubMed] [Google Scholar]17. Romano C, Presenti L, Massai L. Interdigital intertrigo of the feet due to therapy-resistant Fusarium solani. Dermatology. 1999;199(2):177–179. [PubMed] [Google Scholar]18. Varon AG, Nouer SA, Barreiros G, et al. Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive fusariosis. J Infect. 2014;68(1):85–89. [PubMed] [Google Scholar]19. Bazin JC, Hutinel B. Intertrigos mycosiques et lymphangites [Fungal intertrigo and lymphangitis (author’s transl)] J Mal Vasc. 1980;5(2):107–108. French. [PubMed] [Google Scholar]20. Karaca S, Kulac M, Cetinkaya Z, Demirel R. Etiology of foot intertrigo in the District of Afyonkarahisar, Turkey: a bacteriologic and mycologic study. J Am Podiatr Med Assoc. 2008;98(1):42–44. [PubMed] [Google Scholar]21. de González MI, Mendoza M, Bastardo de Albornoz M, Apitz-Castro R. Efectos del ajoeno sobre dermatofitos, Candida albicans y Malassezia furfur [Activity of ajoene on dermatophytes, Candida albicans and Malassezia furfur.] Rev Iberoam Micol. 1998;15(4):277–281. Spanish. [PubMed] [Google Scholar]22. Katoh T, Kagawa S, Ishimoto M. Malassezia intertrigo, a new clinical entity. Mycoses. 1988;31(11):558–562. [PubMed] [Google Scholar]23. Gorani A, Oriani A, Klein EF, Veraldi S. Case report. Erythrasmoid pityriasis versicolor. Mycoses. 2001;44(11–12):516–517. [PubMed] [Google Scholar]24. Beaulieu P, Le Guyadec T, Ponties-Leroux B, Boutchnei S, Grossetete G, Millet P. Cas pour diagnostic: intertrigo a Pseudomonas aeruginoasa [A case for diagnosis: Pseudomonas aeruginosa intertrigo] Ann Dermatol Venereol. 1992;119(3):223–225. French. [PubMed] [Google Scholar]25. Block SL. Tricky triggers of intertrigo. Pediatr Ann. 2014;43(5):171–176. [PubMed] [Google Scholar]26. Dekio I, Matsuki S, Morita E. High carriage rate of Staphylococcus aureus and Streptococcus agalactiae in nine cases of fungus-free intertrigo of the toe cleft. Int J Dermatol. 2014;53(4):484–486. [PubMed] [Google Scholar]27. Adisen E, Onder M. Viral infections of the folds (intertriginous areas) Clin Dermatol. 2015;33(4):429–436. [PubMed] [Google Scholar]28. Bandyopadhyay D, Ghosh SK. Mucocutaneous features of Chikungunya fever: a study from an outbreak in West Bengal, India. Int J Dermatol. 2008;47(11):1148–1152. [PubMed] [Google Scholar]29. Calikoglu E, Soravia-Dunand VA, Perriard J, Saurat JH, Borradori L. Acute genitocrural intertrigo: a sign of primary human immunodeficiency virus type 1 infection. Dermatology. 2001;203(2):171–173. [PubMed] [Google Scholar]30. Yell JA, Sinclair R, Mann S, Fleming K, Ryan TJ. Human papillomavirus type 6-induced condylomata: an unusual complication of intertrigo. Br J Dermatol. 1993;128(5):575–577. [PubMed] [Google Scholar]31. López-Martinez R. Candidosis, a new challenge. Clin Dermatol. 2010;28(2):178–184. [PubMed] [Google Scholar]32. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;26(4):e1–e50. [PMC free article] [PubMed] [Google Scholar]33. Pfaller MA, Andes DR, Diekema DJ, et al. Epidemiology and outcomes of invasive candidiasis due to non-albicans species of Candida in 2,496 patients: data from the Prospective Antifungal Therapy (PATH) Registry 2004–2008. PLoS ONE. 2014;9(7):e101510. [PMC free article] [PubMed] [Google Scholar]34. Sullivan DJ, Westerneng TJ, Haynes KA, Bennett DE, Coleman DC. Candida dubliniensis sp. nov.: phenotypic and molecular characterization of a novel species associated with oral candidosis in HIV-infected individuals. Microbiology. 1995;141(Pt 7):1507–1521. [PubMed] [Google Scholar]36. Kühbacher A, Burger-Kentischer A, Rupp S. Interaction of Candida species with the skin. Microorganisms. 2017;5(2):32. [Google Scholar]38. Naglik JR, Moyes DL, Wachtler B, Hube B. Candida albicans interactions with epithelial cells and mucosal immunity. Microbes Infect. 2011;13(12–13):963–976. [PMC free article] [PubMed] [Google Scholar]39. Höfs S, Mogavero S, Hube B. Interaction of Candida albicans with host cells: virulence factors, host defense, escape strategies, and the microbiota. J Microbiol. 2016;54(3):149–169. [PubMed] [Google Scholar]42. Moyes DL, Runglall M, Murciano C, et al. A biphasic innate immune MAPK response discriminates between the yeast and hyphal forms of Candida albicans in epithelial cells. Cell Host Microbe. 2010;8(3):225–235. [PMC free article] [PubMed] [Google Scholar]43. Schaller M, Mailhammer R, Grassl G, Sander CA, Hube B, Korting HC. Infection of human oral epithelia with Candida species induces cytokine expression correlated to the degree of virulence. J Invest Dermatol. 2002;118(4):652–657. [PubMed] [Google Scholar]44. Villar CC, Kashleva H, Mitchell AP, Dongari-Bagtzoglou A. Invasive phenotype of Candida albicans affects the host proinflammatory response to infection. Infect Immun. 2005;73(8):4588–4595. [PMC free article] [PubMed] [Google Scholar]45. Weindl G, Naglik JR, Kaesler S, et al. Human epithelial cells establish direct antifungal defense through TLR4-mediated signaling. J Clin Invest. 2007;117(12):3664–3672. [PMC free article] [PubMed] [Google Scholar]46. Wang X, van de Veerdonk FL, Netea MG. Basic genetics and immunology of Candida infections. Infect Dis Clin North Am. 2016;30(1):85–102. [PubMed] [Google Scholar]47. Guidelines of care for superficial mycotic infections of the skin: mucocutaneous candidiasis. Guidelines/Outcome Committee. American Academy of Dermatology. J Am Acad Dermatol. 1996;34(1):110–115. [PubMed] [Google Scholar]48. De Britto LJ, Yuvaraj J, Kamaraj P, Poopathy S, Vijayalakshmi G. Risk factors for chronic intertrigo of the lymphedema leg in southern India: a case-control study. Int J Low Extrem Wounds. 2015;14(4):377–383. [PubMed] [Google Scholar]49. Hay RJ, Ashbee HR. Fungal infections. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th. Chichester, West Sussex: John Wiley & Sons Inc; 2016. pp. 32.56–32.70. [Google Scholar]51. James WD, Andrews GC, Berger TG, Elston DM. Diseases resulting from fungi and yeasts. In: James WD, Berger T, Elston D, editors. Andrews’ Diseases of the Skin: Clinical Dermatology. 12th. Philadelphia, PA: Saunders Elsevier; 2016. pp. 285–318. [Google Scholar]52. Lisboa C, Santos A, Dias C, Azevedo F, Pina-Vaz C, Rodrigues A. Candida balanitis: risk factors. J Eur Acad Dermatol Venereol. 2010;24(7):820–826. [PubMed] [Google Scholar]53. Lu SY. Perception of iron deficiency from oral mucosa alterations that show a high prevalence of Candida infection. J Formos Med Assoc. 2016;115(8):619–627. [PubMed] [Google Scholar]54. Mamatha KV, Shubha U, Jain CM. Clinical evaluation of the efficacy of Khadiradi yoga avachoornana in Kachchu with special reference to genitoinguinal intertrigo. Ayu. 2010;31(4):461–465. [PMC free article] [PubMed] [Google Scholar]55. Ndiaye M, Taleb M, Diatta BA, et al. Etiology of intertrigo in adults: a prospective study of 103 cases. J Mycol Med. 2017;27(1):28–32. [PubMed] [Google Scholar]56. Rockwell PG. Acute and chronic paronychia. Am Fam Physician. 2001;63(6):1113–1116. [PubMed] [Google Scholar]57. Ryan KJ, Ray CG. Candida, Aspergillus, Pneumocystis, and other opportunistic fungi. In: Ryan KJ, Ray CG, editors. Sherris Medical Microbiology. 6th. New York: McGraw-Hill Education Medical; 2014. pp. 729–743. [Google Scholar]59. Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatol Ther. 2010;23(3):230–242. [PubMed] [Google Scholar]60. Silverman RA, Schwartz RH. Streptococcal intertrigo of the cervical folds in a five-month-old infant. Pediatr Infect Dis J. 2012;31(8):872–873. [PubMed] [Google Scholar]62. Asiedu DK. Candidiasis, cutaneous. In: Ferri FF, editor. Ferri’s Clinical Advisor 2018: 5 Books in 1. Amsterdam: Elsevier Science Health Science; 2017. pp. 234–235.e231. [Google Scholar]63. Habif TP. Superficial fungal infections. In: Habif TP, editor. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th. Philadelphia, PA: Saunders; 2016. pp. 487–533. [Google Scholar]64. Hay RJ. Fungal infections of the skin. In: Olafsson JH, Hay RJ, editors. Antibiotic and Antifungal Therapies in Dermatology. Switzerland: Springer; 2016. pp. 157–186. [Google Scholar]65. Kauffman CA. Candidiasis. In: Goldman L, Schafer AI, editors. Goldman-Cecil Medicine. 25th. Philadelphia, PA: Elsevier/Saunders; 2016. pp. 2079–2083.e2072. [Google Scholar]66. Mistiaen P, van Halm-Walters M. Prevention and treatment of intertrigo in large skin folds of adults: a systematic review. BMC Nurs. 2010;9:12. [PMC free article] [PubMed] [Google Scholar]67. Wilmer EN, Hatch RL. Resistant “candidal intertrigo”: could inverse psoriasis be the true culprit? J Am Board Fam Med. 2013;26(2):211–214. [PubMed] [Google Scholar]68. Valenti L. Topical treatment of intertriginous candidal infection. Mycoses. 2008;51(Suppl 4):44–45. [PubMed] [Google Scholar]69. Terzieva K, Elsner P. A case of intertrigo resistant to treatment – what is your diagnosis? J Dtsch Dermatol Ges. 2015;13(2):169–171. [PubMed] [Google Scholar]70. Smith SM, Milam PB, Fabbro SK, Gru AA, Kaffenberger BH. Malignant intertrigo: a subset of toxic erythema of chemotherapy requiring recognition. JAAD Case Rep. 2016;2(6):476–481. [PMC free article] [PubMed] [Google Scholar]71. Santiago-et-Sanchez-Mateos JL, Beà S, Fernández M, Pérez B, Harto A, Jaén P. Botulinum toxin type A for the preventive treatment of intertrigo in a patient with Darier’s disease and inguinal hyperhidrosis. Dermatol Surg. 2008;34(12):1733–1737. [PubMed] [Google Scholar]72. Nazzaro G, Vaira F, Coggi A, Gianotti R. A 42-year-old woman with a submammary intertrigo. Int J Dermatol. 2013;52(9):1035–1036. [PubMed] [Google Scholar]73. López-Corominas V, Yagüe F, Knöpfel N, et al. Streptococcus pyogenes cervical intertrigo with secondary bacteremia. Pediatr Dermatol. 2014;31(2):e71–e72. [PubMed] [Google Scholar]74. Imam TH, Cassarino D, Patail H, Khan N. Refractory intertrigo in the right inguinal crease: challenge. Am J Dermatopathol. 2017;39(8):629. [PubMed] [Google Scholar]75. Dowd ML, Ansell LH, Husain S, Grossman ME. Papular acantholytic dyskeratosis of the genitocrural area: a rare unilateral asymptomatic intertrigo. JAAD Case Rep. 2016;2(2):132–134. [PMC free article] [PubMed] [Google Scholar]76. McKay C, McBride P, Muir J. Plantar verrucous carcinoma masquerading as toe web intertrigo. Australas J Dermatol. 2012;53(2):e20–e22. [PubMed] [Google Scholar]77. Butragueño Laiseca L, Toledo Del Castillo B, Marañón Pardillo R. Cervical intertrigo: think beyond fungi. Rev Chil Pediatr. 2016;87(4):293–294. [PubMed] [Google Scholar]78. Kirkpatrick CH. Chronic mucocutaneous candidiasis. Pediatr Infect Dis J. 2001;20(2):197–206. [PubMed] [Google Scholar]79. Hoeger PH, Stark S, Jost G. Efficacy and safety of two different antifungal pastes in infants with diaper dermatitis: a randomized, controlled study. J Eur Acad Dermatol Venereol. 2010;24(9):1094–1098. [PubMed] [Google Scholar]80. Blanco D, van Rossem K. A prospective two-year assessment of miconazole resistance in Candida spp with repeated treatment with 025% miconazole nitrate ointment in neonates and infants with moderate to severe diaper dermatitis complicated by cutaneous candidiasis. Pediatr Dermatol. 2013;30(6):717–724. [PubMed] [Google Scholar]81. Chiriac A, Chiriac AE, Pinteala T, Foia L, Brzezinski P. Erosio blastomycetica interdigitale sign of Candidiasis and diabetes! Bangladesh J Med Sci. 2014;13(1):105–106. [Google Scholar]83. Gjessing HC. Intertrigo; saerlig omtale av perianal, (retro) aurikulaer og periokulaer intertrigo [Intertrigo, with special consideration on perianal, retroauricular and periocular intertrigo] Tidsskr Nor Laegeforen. 1953;73(12):488–490. Norwegian. [PubMed] [Google Scholar]85. Tulipan L. Intertrigo (chafing) treated with tannic acid and brilliant green. J Am Med Ass. 1941;116(14):1518–1519. [Google Scholar]86. Dogan B, Karabudak O. Treatment of candidal intertrigo with a topical combination of isoconazole nitrate and diflucortolone valerate. Mycoses. 2008;51(Suppl 4):42–43. [PubMed] [Google Scholar]87. Janik MP, Heffernan MP. Yeast infections: candidiasis and tinea (pityriasis) versicolor. In: Wolf K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology in General Medicine. 7th. New York: McGraw-Hill Medical; 2008. pp. 1822–1830. [Google Scholar]88. Verma S, Heffernan M. Fungal infections. In: Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, editors. Fitzpatrick’s Dermatology in General Medicine. 7th. New York: McGraw-Hill Medical; 2008. pp. 1807–1821. [Google Scholar]89. Elewski BE, Hughey LC, Sobera JO, Hay R. Fungal diseases. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd. [Edinburgh]: Elsevier/Saunders; 2012. pp. 1251–1284. [Google Scholar]90. Rowen JL. Mucocutaneous candidiasis. Semin Perinatol. 2003;27(5):406–413. [PubMed] [Google Scholar]91. Rashid A. Arthroconidia as vectors of dermatophytosis. Cutis. 2001;67(5 Suppl):23–23. [PubMed] [Google Scholar]92. Pryzbilla B, Rueff F. Contact dermatitis. In: Burgdorf WHC, Braun-Falco O, editors. Braun-Falco’s Dermatology. 3rd. Heidelberg: Springer; 2009. pp. 491–540. [Google Scholar]93. Reiss E, Shadomy HJ, Lyon GM. Fundamental Medical Mycology. Hoboken, NJ: John Wiley & Sons; 2012. pp. 250–301. [Google Scholar]94. Loo DS. Cutaneous fungal infections in the elderly. Dermatol Clin. 2004;22(1):33–50. [PubMed] [Google Scholar]95. Draijer LW, Folmer H. NHG-Farmacotherapeutische richtlijn Intertrigo. Huisarts en Wetenschap. 2007;50(1):33–35. [Google Scholar]96. Bazex J. Intertrigo. Diagnostic orientation. Rev Prat. 1992;42(13):1689–1692. [PubMed] [Google Scholar]97. Benkalfate L, Zein K, le Gall F, Chevrant-Breton J, Rivalan J, le Pogamp P. Calcified intertrigo, a rare cause of cutaneous calcinosis. Ann Dermatol Venereol. 1995;122(11–12):789–792. [PubMed] [Google Scholar]98. Carleton A. A case of pseudomembiunous intertrigo. Br J Dermatol. 1943;55(6):154–158. [Google Scholar]99. Collier C. Within the fold: treatments of intertrigo. JAAD. 2007;56(2):AB126. [Google Scholar]100. Honig PJ, Frieden IJ, Kim HJ, Yan AC. Streptococcal intertrigo: an underrecognized condition in children. Pediatrics. 2003;112(6 Pt 1):1427–1429. [PubMed] [Google Scholar]101. Ke CL, Chen CC, Lin CT, Chen GS, Chai CY, Cheng ST. Fluvoxamine-induced bullous eruption mimicking hand-foot syndrome and intertrigo-like eruption: rare cutaneous presentations and elusive pathogenesis. J Am Acad Dermatol. 2006;55(2):355–356. [PubMed] [Google Scholar]102. Korver GE, Ronald H, Petersen MJ. An intertrigo-like eruption from pegylated liposomal doxorubicin. J Drugs Dermatol. 2006;5(9):901–902. [PubMed] [Google Scholar]103. Plaza AI, Sancho MI, Millet PU, et al. Erythematous, vesicular, and circinate lesions in a 78-year-old female – benign familial pemphigus. An Bras Dermatol. 2017;92(3):439–440. [PMC free article] [PubMed] [Google Scholar]104. Millsop JW, Fazel N. Oral candidiasis. Clin Dermatol. 2016;34(4):487–494. [PubMed] [Google Scholar]105. Sundaram SV, Srinivas CR, Thirumurthy M. Candidal intertrigo: treatment with filter paper soaked in Castellani’s paint. Indian J Dermatol Venereol Leprol. 2006;72(5):386–387. [PubMed] [Google Scholar]106. Chadbourne EB, Zhang S, Gordon MJ, et al. Clinical outcomes in reduction mammaplasty: a systematic review and meta-analysis of published studies. Mayo Clin Proc. 2001;76(5):503–510. [PubMed] [Google Scholar]107. Ding X, Yan D, Sun W, Zeng Z, Su R, Su J. Epidemiology and risk factors for nosocomial non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China. Med Mycol. 2015;53(7):684–690. [PubMed] [Google Scholar]

What Is It, Causes, Symptoms & Treatment

Overview

What is intertrigo?

Intertrigo is a common inflammatory skin condition that is caused by skin-to-skin friction (rubbing) that is intensified by heat and moisture. It usually looks like a reddish rash. Trapped moisture, which is usually due to sweating, causes the surfaces of your skin to stick together in your skin folds. The moisture increases the friction, which leads to skin damage and inflammation.

In many cases of intertrigo, damage to the skin allows bacteria and/or fungus normally present on the surface of your skin to overgrow. The warmth, trapped moisture and friction-induced skin damage create an ideal environment for bacteria and fungi to grow and multiply. This overgrowth of bacteria and/or fungi triggers your immune system to respond, which results in secondary inflammation and a visible rash. In more severe cases, the bacterial and/or fungal overgrowth is significant enough to cause a secondary infection.

Is intertrigo a fungal infection?

Intertrigo itself is not an infection. It’s an inflammatory skin condition. However, intertrigo often leads to a fungal or bacterial infection. This is known as a secondary infection. Candida — a type of yeast, or fungus — is the most common cause of secondary infection related to intertrigo.

What parts of the body get intertrigo?

Intertrigo can appear in between any skin areas that are in close contact with each other, such as skin folds, and that are often moist.

The most common places that intertrigo occurs include:

  • In the crease(s) of your neck.
  • In your armpits.
  • Beneath or between your breasts.
  • Between your belly folds.
  • Between your buttocks.
  • In your groin at your scrotum.
  • In your inner thighs.
  • Between your toes and fingers.

Babies are especially at risk for intertrigo because their skin is delicate and they’re more likely to have moist skin from drooling or from wearing diapers. The most common places for babies to have intertrigo include:

  • On their buttocks or in their groin area (often referred to simply as diaper rash).
  • In between their neck folds.
  • In the creases of their skin rolls or folds on their arms and legs.

Are there different kinds of intertrigo?

There are a few names for intertrigo (also known as intertriginous dermatitis) depending on certain factors such as where it appears and if it’s caused an infection or not. Your healthcare provider may use one or more of these terms to describe your intertrigo:

  • Acute intertrigo: If your intertrigo just recently appeared, it’s called acute intertrigo.
  • Recurrent intertrigo: If you’ve had multiple cases of intertrigo over time, it’s called recurrent (relapsing) intertrigo.
  • Chronic intertrigo: If your case of intertrigo has lasted six weeks or more, it’s called chronic intertrigo.
  • Uncomplicated intertrigo: Uncomplicated intertrigo means your intertrigo has not caused an infection.
  • Interdigital intertrigo: Intertrigo between your fingers or toes is called interdigital intertrigo.
  • Candidal intertrigo: Candidal intertrigo happens when your intertrigo becomes infected by the yeast (fungus) Candida. Candida is the most common cause of intertrigo infections.
  • Diaper rash: Also known as diaper dermatitis, diaper rash is a form of intertrigo.

Can intertrigo spread to other parts of my body?

You can have intertrigo in more than one place on your body at the same time, but intertrigo does not spread to other parts of your body. This is because a key contributing factor for intertrigo is friction from skin-to-skin rubbing, so only places on your body where your skin rubs together can have intertrigo.

If you get an infection from your intertrigo, the infection can spread to other parts of your body and can cause serious complications. It’s important to see your healthcare provider as soon as possible if you have signs of an infection.

Who gets intertrigo?

Anyone at any age can get intertrigo. Babies often get diaper rash (diaper dermatitis), which is a form of intertrigo. People who have obesity, diabetes and/or a weakened immune system due to underlying disease or medication are more likely to get intertrigo.

How common is intertrigo?

Intertrigo is a common skin condition. It’s most common in hot and humid environments and during the summer.

Symptoms and Causes

What causes intertrigo?

Intertrigo is caused by skin-to-skin friction that is made worse by heat and moisture. This most commonly happens between skin folds or creases and between your toes or fingers.

The trapped moisture — often due to sweating — causes your skin surfaces to stick together. This increases the friction between your skin surfaces, which causes skin damage, bacterial and/or fungal overgrowth and inflammation. In many cases of intertrigo, the skin breaks open from the friction, which allows bacteria and/or fungus to get into your skin, causing an infection. The moisture and warmth make a perfect environment for bacteria and fungi to multiply. If the affected area comes in contact with sweat, pee or poop, it can make your intertrigo worse.

Different kinds of fungi and bacteria that can cause secondary infections include:

  • Candida: Candida, a type of yeast and fungus, is the most common cause of secondary infections in intertrigo cases.
  • Dermatophytes: Dermatophytes are fungi that require keratin (a type of protein) for growth. These fungi can cause infections in your skin and nails. Dermatophyte fungi often cause secondary infections from intertrigo in between your fingers or toes.
  • Staphylococcus aureus: This bacteria — often called staph — is a common cause of intertrigo bacterial infections.

What are the signs and symptoms of intertrigo?

Signs and symptoms of intertrigo depend on how severe it is and if there is an infection or not.

Early symptoms of intertrigo without infection can include:

  • Having a somewhat symmetrical red or reddish-brown rash with small bumps in an area where your skin rubs against itself.
  • Having itching, stinging and/or burning in the affected area.
  • Feeling uncomfortable or experiencing pain in the affected area.

If intertrigo is not treated in its early phase, you can develop the following symptoms:

  • Feeling like your affected skin is raw.
  • Having cracks in your affected skin.
  • Experiencing bleeding or oozing from your affected skin.
  • Having skin that is crusted over and/or scaly in the affected area.

Symptoms of intertrigo with an infection can include:

  • Having a foul smell in the affected area.
  • Having bumps on your affected skin that contain pus.
  • Having raised, tender bumps on your affected skin.

If you have signs of an infection, it’s important to see your healthcare provider or go to the nearest hospital as soon as possible. Infections need proper medical treatment and can lead to serious complications if they’re left untreated.

Is intertrigo contagious?

Intertrigo is not contagious. You can’t get it from another person or spread it to another person.

Diagnosis and Tests

How is intertrigo diagnosed?

Even though intertrigo is a common condition, it can be difficult to diagnose because it can look like other skin conditions that can affect skin folds. Your healthcare provider will ask you thorough questions about your history, focusing on any skin conditions you currently have or have had in the past. They’ll also ask you questions about medications you take, allergies and sensitivities you may have and if you’ve used certain kinds of topical ointments or soaps. They’ll then do a visual examination of your affected skin.

If your provider suspects you have an infection from your intertrigo, they may perform certain tests such as a skin scraping to see what kind of organism is causing the infection.

What tests will be done to diagnose intertrigo?

There’s currently no formal test or assessment tool to diagnose intertrigo. Your healthcare provider will diagnose your intertrigo based on thorough questions about your history and a visual exam of your affected skin.

If your healthcare provider thinks you may have an infection from your intertrigo, they may perform one or more of the following tests:

  • Wood’s lamp examination: A Wood’s lamp is a small tool that uses black light to illuminate areas of your skin. Your healthcare provider will hold the tool over your affected skin in a darkened room. If a certain kind of bacteria or fungi is causing your infection, the light will cause the affected area of your skin to change color.
  • Skin scraping: Your healthcare provider will use a tool to scrape and remove some of your affected skin. They will then look at the skin sample under a microscope to see what kind of fungus or bacteria is causing your infection.
  • Skin biopsy: Your healthcare provider will use local anesthesia and a biopsy tool to remove a small piece of your skin. A laboratory technician or a pathologist will then examine it under a microscope to ensure an accurate diagnosis.

Management and Treatment

How is intertrigo treated?

The main way to treat intertrigo that hasn’t caused an infection is by keeping the affected area dry, clean and cool.

Ways you can keep your intertrigo dry, clean and cool at home include:

  • Dry yourself thoroughly with a clean towel after you take a shower. Dry the affected area by patting it with a towel, not rubbing it.
  • Use a fan or a hairdryer on the “cool” setting over the affected area multiple times a day.
  • Wear loose clothing and breathable fabrics, such as cotton.
  • Use a mild antiperspirant (deodorant) in your armpits or under your breasts to minimize sweating.
  • Use a powder drying agent, such as talcum powder, on your affected area. If you use an ointment for your intertrigo, do not use it and powder at the same time. They will create a tacky paste.

Other things you can do to treat uninfected intertrigo include:

  • Use skin barrier creams or anti-chafing gels: Creams or ointments with zinc oxide and/or petrolatum can help reduce friction between your affected skin by creating a barrier.
  • Use fiber skin barriers: Use materials such as clean gauze or cotton to separate the affected skin that is touching can help reduce friction.
  • Use a topical steroid cream: Your healthcare provider may recommend a topical steroid cream to help with inflammation. You can buy mild steroid creams at your local pharmacy without a prescription.
  • Use topical anti-fungal and/or anti-bacterial creams: Your healthcare provider may recommend a topical steroid cream to help combat fungal and bacterial overgrowth that contributes to inflammation. You can buy anti-fungal and anti-bacterial creams at your local pharmacy without a prescription.

Treatment for intertrigo that has caused an infection depends on what caused it. Your healthcare provider will need to find out what kind of bacteria or fungi have caused your infection in order to give you proper treatment.

Treatment for infected intertrigo can include:

  • Antifungal cream: If you have an infection that’s caused by a fungus, your healthcare provider may have you use a specific topical antifungal cream or ointment on the affected area.
  • Antibiotic cream: If you have an infection that’s caused by bacteria, your provider may have you use a specific topical antibacterial cream or ointment on the affected area.
  • Oral medication: Your provider may prescribe you one or more oral medications (pills) in order to treat your infection. These could include antibiotics or antifungal medications.

Prevention

What are the risk factors for getting intertrigo?

Risk factors for getting intertrigo include:

  • Obesity: Intertrigo is strongly associated with having obesity. People who have obesity usually have more pronounced skin folds and increased sweating. It can also be more difficult for people with obesity to properly clean and care for their skin folds.
  • Diabetes: Having diabetes can cause increased sweating, which helps contribute to intertrigo. In addition, having diabetes and chronic high blood sugar can increase your skin surface pH, which makes it more ideal for bacteria and fungi to grow and multiply. This can put people with diabetes at a higher risk of getting an infection from intertrigo.
  • Incontinence: People who have urinary incontinence (not being able to control their bladder) and/or fecal incontinence (not being able to control their bowel movements) are at higher risk for intertrigo because pee and/or poop in an absorbent undergarment creates a warm and moist environment. If you already have intertrigo, contact with sweat, pee or poop can make your intertrigo worse.
  • Excessive sweating: Excessive sweating (known as hyperhidrosis) can put you at a higher risk of intertrigo.
  • Excess skin from significant weight loss: People who have excess skin from significant weight loss are more likely to get intertrigo due to the skin folds rubbing together.
  • Living in a hot and humid environment: Intertrigo is caused by skin friction due to trapped moisture, so living in a hot and humid environment, where you are more likely to sweat, puts you at a higher risk of getting intertrigo.
  • Your age: Intertrigo is more common in babies and older people. Babies are at a higher risk for intertrigo because their skin is sensitive and they often have moist skin from drooling or from wearing diapers. It can be more difficult for older people to bathe and care for their skin routinely, so they’re at a higher risk for intertrigo.

What can I do to prevent intertrigo?

There are several things you can do to try to prevent getting intertrigo, including:

  • Keep your skin cool, dry and clean, especially areas where your skin rubs together.
  • Shower and dry off completely every day and especially after you exercise or sweat.
  • Avoid wearing tight clothes or shoes.
  • Wear clothes that are made of breathable and absorbent fabrics, such as cotton, and avoiding clothes made of synthetic materials.
  • Use a skin barrier protectant cream if you have incontinence.
  • Change your child’s diaper frequently to prevent diaper rash (a form of intertrigo).

If you’ve had repeated cases of intertrigo, the following actions may help to prevent future cases:

  • Have a structured skincare routine: Talk to your healthcare provider or a dermatologist about a skincare routine that could help prevent intertrigo. The plan could include gentle cleansing, moisturizing and using a skin barrier protectant such as zinc oxide or petroleum jelly.
  • Lose weight: If you have obesity, losing weight could help prevent future cases of intertrigo. See your healthcare provider and/or a registered dietician to discuss ways you can healthily and safely lose weight.
  • Have a breast reduction: If you’ve had cases of intertrigo under your breasts, a breast reduction could help. Talk to your healthcare provider.
  • Have body contouring surgery: If you’ve had cases of intertrigo due to having excess skin from significant weight loss, talk to your provider about body contouring surgeries, such as tummy tuck (abdominoplasty) and brachioplasty, to remove extra skin.

Outlook / Prognosis

What is the outlook for intertrigo?

While intertrigo can be unpleasant and painful, it is treatable. The prognosis (outlook) for intertrigo depends on the person’s overall health. In most cases, people recover well from intertrigo if it’s treated properly.

Intertrigo can become chronic (long-lasting) or recurrent (occurring often), so it’s important to take care of yourself and follow a proper hygiene routine to prevent your intertrigo from coming back.

Can intertrigo cause complications?

If intertrigo is not treated properly, it can cause complications, including:

  • Nail fungal infections: If a fungal infection from intertrigo that is between your toes or fingers is not treated properly, it can cause a fungal infection in your toenails or fingernails.
  • Cellulitis: Cellulitis is a deep infection of the skin and soft tissue caused by bacteria. If cellulitis is not treated properly, it can be life-threatening. This complication is more common in people who have diabetes and intertrigo.
  • Sepsis: If you have an infection caused by intertrigo that is not treated, it could lead to sepsis. Sepsis is a medical emergency caused by the body’s response to systemic infection. It can be life-threatening.

Living With

When should I see my healthcare provider?

If you have a skin rash that isn’t going away or suddenly gets worse, it’s important to see your healthcare provider. There are many different kinds of skin rashes — many of which look very similar —so your provider will want to make sure your rash is in fact intertrigo and not something else.

If you have been diagnosed with intertrigo and your intertrigo doesn’t seem to be getting better with treatment, contact your healthcare provider.

If you have signs of an infection from your intertrigo — such as a foul smell in the affected area or pus—be sure to see your healthcare provider as soon as possible or go to the nearest hospital. Infections need proper medical treatment.

If you’ve had multiple cases of intertrigo over time (recurrent intertrigo), talk to your healthcare provider about how you can prevent it from coming back and more permanent solutions for prevention.

A note from Cleveland Clinic

While intertrigo can be unpleasant and painful, the good news is that it’s treatable and often preventable. Try your best to prevent intertrigo by keeping your skin clean, dry and cool, especially if you’re at a higher risk of getting it. If you have symptoms of intertrigo, be sure to contact your healthcare provider. You will receive a proper diagnosis and a treatment plan so that you can feel better soon.

Candidal intertrigo | DermNet NZ

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


What is candidal intertrigo?

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

Candida intertrigo

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[1] 
  • Increased skin friction [2]
  • Immunocompromise [3].

Who gets candidal intertrigo?

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

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 [2,5,6].

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) [2,5,6]. 

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 [7]. Skin biopsy is usually not necessary.

What is the differential diagnosis for candidal intertrigo?

Other forms of intertrigo should be considered, including:

How is candidal intertrigo treated?

  • Predisposing factors should be addressed primarily, such as weight loss, blood glucose control and avoidance of tight clothing [8,9].
  • 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 [7,10].
  • Topical antifungal agents such as clotrimazole cream are recommended as first-line pharmacological treatments [10–12].
  • Severe, generalised and/or refractory cases may require oral antifungal treatments such as fluconazole or itraconazole[10–12].

 

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 NZ

Other websites

Books about skin diseases

Intertrigo: Practice Essentials, Background, Pathophysiology

Background

Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.

Intertrigo frequently is worsened by infection, which most commonly is with Candida species. Bacterial, viral, or other fungal infection may also occur.

Intertrigo commonly affects the axilla, perineum, inframammary creases, and abdominal folds. Uncommonly, it can also affect the neck creases and interdigital areas.

Signs and symptoms of intertrigo

Intertrigo usually is chronic with an insidious onset of itching, burning, pain, and stinging in the skin folds.

Intertrigo initially presents as mild erythematous patches on both sides of the skinfold. The erythematous lesions may progress to weeping, erosions, fissures, maceration, or crusting.

Worsening erythema or inflammation could suggest the development of a secondary cutaneous infection.

Etiology of intertrigo

Intertrigo develops from mechanical factors and secondary infection. Heat and maceration are central to the process. Opposing skin surfaces rub against each other, at times causing erosions that become inflamed.

Secondary cutaneous infections can be caused by a variety of gram-positive or gram-negative bacteria or fungi, including various yeasts and dermatophytes.

Diagnosis of intertrigo

Basic microbiologic diagnostic studies can be performed to identify a potential causative agent of intertrigo and guide antimicrobial therapy.

Potassium hydroxide (KOH) test, Gram stain, or culture is useful to exclude primary or secondary infection and to guide intertrigo therapy.

A skin biopsy generally is not required unless the intertrigo is refractory to medical treatment.

Treatment of intertrigo

Simple intertrigo may be treated with drying agents

Infected intertrigo should be treated with a combination of an appropriate antimicrobial agent (antifungal or antibacterial) and low-potency topical steroid. 

Prevention of intertrigo

During patient instruction, emphasize topics such as weight loss, glucose control (in patients with diabetes), good hygiene, and the need for daily care and monitoring. Additionally, preventative measures to reduce skin-on-skin friction and moisture can help in the management of current intertrigo and prevent future episodes.

Complications

Since intertrigo frequently is colonized or secondarily infected, secondary cutaneous infections and acute cellulitis can occur.

What to Do for Intertrigo

Many people have experienced intertrigo, which is the medical term for a skin rash that occurs whenever a moist skin fold chafes and becomes infected. Women with large breasts often experience this rash beneath the bra band, and overweight people might develop intertrigo in abdominal skin folds or those of the groin. Intertrigo tends to be more common in people who are overweight, bed-bound, use artificial limbs, or live in hot, humid climates, but the condition can occur in anyone. The key to intertrigo treatment lies in drying out the rash and eliminating the skin infection.

Signs and Symptoms of Intertrigo

Because intertrigo is so common, you probably can identify it yourself. Intertrigo occurs due to chafing—when two areas of skin rub together. Intertrigo most commonly occurs in skin folds of the neck, armpits, elbows, breasts, knees, abdomen, groin or between the toes. Other common signs and symptoms of intertrigo include:

  • Burning, itching or pain within the irritated skin fold

  • Raw-looking skin within a fold

  • Well-defined red rash that may also be weepy (oozing)

  • Yeast-like or putrid odor from the rash

Other types of skin rashes, such as allergic contact dermatitis or eczema can resemble intertrigo, so if you’ve never experienced intertrigo before you should see your primary care provider or a dermatologist for a diagnosis. Once you’ve been diagnosed with intertrigo, you will recognize it each time it occurs and intervene quickly with home treatments.

Home Remedies for Intertrigo

Intertrigo home treatment has two main goals: dry out the skin fold and treat the skin infection causing the rash. To dry the skin fold and keep it dry, try these home remedies:

  • Place an absorbent dressing (such as a telfa pad, menstrual pad, or gauze) against the rash and changing it regularly.

  • Use a fan or blow dryer on the cool setting to air out the skin fold.

  • Use a soft towel to gently dry the area several times a day.

  • Wear clothing made of moisture-wicking fabric.

  • Wear loose clothing to avoid trapping moisture against the skin.

Once the rash has cleared up, apply powder to skin folds after every shower. Be sure to cleanse skin folds regularly (and gently) to reduce the risk of fungal or bacterial growth.
Some people find relief with a vinegar treatment for intertrigo. Mix one tablespoon of vinegar into one quart of lukewarm water. Soak a soft cloth in this solution and apply to the rash twice daily for up to 10 minutes. Dry thoroughly.

For weeping rashes, an over-the-counter Burow solution (water and aluminum acetate) can help dry out the area too, preventing irritation and reinfection.

While you are taking steps to dry out the affected skin folds, you also must treat the underlying fungal or bacterial infection causing the rash. Over-the-counter intertrigo treatments include antifungal powders (preferred over creams, which keep the skin fold moist), topical corticosteroid creams, and antibacterial ointments. Do not overuse antibacterial ointments, as this can cause a different type of rash to develop.

Intertrigo can lead to a serious infection left untreated, so if a home remedy doesn’t work you should see a doctor for treatment. Prescription powders and creams offer more alternatives for eliminating this painful rash quickly.

Candida Skin Infection (Adult)

Candida is a type of yeast. It grows naturally on the skin and in the mouth. If it grows out of control, it can cause an infection. Candida can cause infections in the genital area, skin folds, in the mouth, and under the breasts. Anyone can get this infection. It is more common in a person with a weak immune system, such as from diabetes, HIV, or cancer. It’s also more common in someone who has been on antibiotic therapy. And it’s more common in people who are overweight or who have incontinence. Wearing tight-fitting clothing and taking part in activities with lots of skin-to-skin contact can also put you at risk.

Candida causes the skin to become bright red and inflamed. The border of the infected part of the skin is often raised. The infection causes pain and itching. Sometimes the skin peels and bleeds. In the mouth, candida is called thrush, and may cause white thickened areas.

A Candida rash is most often treated with an antifungal cream, gel, or powder. . The rash will clear a few days after starting the medicine. Infections that don’t go away may need a prescription medicine. In rare cases, a bacterial infection can also occur.

Home care

Your healthcare provider will advise using an antifungal cream, powder, or gel for the rash. He or she may also prescribe a medicine for the itch. Follow all instructions for using these medicines.

General care

  • Keep your skin clean by washing the area twice a day.

  • Use the medicine as directed until your rash is gone. Once the skin has healed, keep it dry to prevent another infection. 

  • If you are overweight, talk with your healthcare provider about a plan to lose extra weight.

  • Don’t wear tight-fitting clothes.

Follow-up care

Follow up with your healthcare provider, or as advised. Your rash will clear in 7 to 14 days. Call your provider if the rash is not gone after 14 days.

When to get medical advice

Call your healthcare provider right away if any of these occur:

  • Pain or redness that gets worse or spreads

  • Fluid coming from the skin

  • Yellow crusts on the skin

  • Fever of 100.4°F (38°C) or higher, or as directed by your provider

Clotrimazole: a medicine used to treat fungal skin infections

How long you use clotrimazole for depends on the type of infection you have.

It’s best to use it for at least 2 weeks, even if all signs of the infection have gone, to stop it from coming back. It can be used for up to 4 weeks if needed.

Apply clotrimazole to the affected area 2 to 3 times a day. It will work better if you use it 3 times a day.

If the affected area is large or hairy, it’s best to use either the spray or solution.

If you’re using clotrimazole on your feet, make sure you wash and thoroughly dry your feet, especially between your toes, before applying clotrimazole.

How to use clotrimazole cream

Apply clotrimazole cream to the affected area. Use the cream on your skin only. A strip of cream (0.5cm long) is enough to treat an area the size of your hand. Avoid putting it near your mouth, lips and eyes.

How to use clotrimazole spray

If you’re using the spray for the first time, prepare the spray by pressing the spray head down once or twice.

Hold and spray about 15cm away from the affected area.

How to use clotrimazole solution

The solution comes in a bottle with a plastic “dropper” which lets the solution out in drops.

Apply clotrimazole solution thinly and evenly to the affected areas.

A few drops of clotrimazole solution should be enough to cover an area the size of a hand.

If your ear is infected, put 2 to 3 drops of clotrimazole solution into your ear.

What if I forget to use it?

If you forget to use your treatment, do not worry. Just apply it as soon as you remember and then keep following your usual routine.

What if I use too much?

If you use too much clotrimazole cream, spray or solution or use it more often than you need to, it may make your skin red or irritated. If this happens, use less the next time.

90,000 Skin mycosis: symptoms, treatment, diagnosis of the disease

Mycoses are called an extensive group of diseases united by one symptom – they are all caused by pathogenic fungi parasitizing the skin, mucous membranes and other human tissues. Among all skin infections, they rank first in terms of prevalence, but despite this, many sick people cannot recognize the disease in time and consult a doctor, which is why dermatologists often have to deal with advanced forms of pathology.

Types of disease

Currently, there are about four hundred different types of fungi that can be pathogenic to humans under certain conditions. Mycoses are distinguished by the type of tissue affected:

  • superficial, affecting the skin and mucous membranes:
  • deep, the affected area is the subcutaneous tissue;
  • visceral, which parasitize the internal organs.

According to the types of fungi that parasitize humans, the following diseases are the most common.

  • Rubrofit. The fungus rubrum trichophyton affects the interdigital spaces, feet, less often settles in the skin folds and on the head. The skin at the site of the lesion turns red and flakes, nodules and small bumps appear on it. When the skin is affected, the trunk forms large patches of reddened skin with bright red concentric ridges.
  • Microsporia. As a rule, the fungus is transmitted from sick cats or dogs and affects the vellus hair on the body, less often the skin with the formation of a focus of inflamed skin with peeling and vesicles, surrounded by a roller.Microspores are resistant to external influences.
  • Trichophytosis. The trichophyton fungus parasitizes the skin, affecting mainly open areas of the body – the face, hands. It is highly contagious. In humans, outbreaks of the disease are most often recorded in late summer and autumn during field work, when people come into contact with hay and straw, on which sick rodents left the infection.
  • Versicolor versicolor. Malassezia furfur is a common cause of mycosis of smooth skin.The lesions, as a rule, form on the chest and abdomen, less often on other parts of the body: small pink spots appear, the color of which then changes to yellow or brown. They are covered with rough scales that look like bran. Multiple spots soon merge into large formations.
  • Seborrheic dermatitis. This is a common mycosis of the scalp, affecting the scalp, including the skin of the eyebrows, eyelashes, mustache and beard, caused by Pityrosporum oval. A variety of pytirosporum orbikular parasitizes on the smooth skin of the trunk.These are lipophilic fungi, for which sebum serves as a breeding ground. The affected areas of the skin are marked with inflammation and flaky crusts.
  • Candidiasis. Yeast-like candida fungi settle in the skin folds, on the mucous membranes and form reddish specks covered with small bubbles. After a while, eroded areas of a bright red color appear in place of the bubbles.

There are many types of mycosis of the skin, subcutaneous tissues and internal organs, which are much less common than the listed types.

Symptoms

It is possible to talk about the symptoms of mycosis only in general terms, since each species has its own manifestations, which can only be recognized by an experienced dermatologist. With skin lesions, as a rule, appear:

  • reddened and scaly areas of the skin;
  • severe itching in places affected by the fungus;
  • diaper rash in the skin folds and interdigital zones;
  • small bubbles, which burst and dry out over time;
  • white, yellow or brownish crusts over inflamed skin.

With mycosis of the extremities, as a rule, the nails also suffer – they become brittle, exfoliate, then gradually grow cloudy and darken.

Deep mycoses, as a rule, proceed with the formation of deep ulcers, purulent inflammations, fistulas, etc. They are most common in countries with hot climates, and are extremely rare in Russia. Visceral, depending on the location and degree of damage, can cause dysfunction of the organs on which the fungi parasitize – lung diseases, digestive disorders, etc.etc.

Do you have symptoms of athlete’s foot?

Only a doctor can accurately diagnose the disease.
Do not delay the consultation – call by phone

+7 (495) 775-73-60

The reasons for the development of pathology

The main cause of mycosis is infection with a pathogenic fungus. At the same time, many types of fungi are constantly present in the body, and their growth is usually inhibited by the immune system. With a decrease in control, the fungus begins to grow on the skin or tissues of internal organs.This is often due to:

  • a chronic disease that weakens the body;
  • non-compliance with hygiene rules;
  • insufficient or unbalanced nutrition;
  • smoking and alcohol abuse;
  • exposure to external factors that weaken the body – hypothermia, excess ultraviolet radiation, poisoning, radiation injury, etc.;
  • long-term use of antibiotics or some other medications.

The only exception to this is the so-called fungal mycosis, which is not a fungal disease. This is an oncological tumor pathology, which is based on the degeneration of T-lymphocytes into a malignant form.

Transmission routes

There are many ways to get infected with fungal diseases. This happens most often:

  • in direct contact with the affected areas of the skin of another person;
  • when sharing towels, slippers, personal hygiene items;
  • through a contaminated nail tool;
  • through contaminated clothing and footwear;
  • through the soil, especially in the presence of skin microtrauma;
  • for contact with pets.

Often, skin mycoses develop in people visiting swimming pools, saunas, showers at sports clubs, etc. The more likely the infection is, the worse the human immune system works.

Diagnostic Methods

As part of the diagnosis of mycoses, studies of scrapings of skin and nail formations, sputum, blood, hair, scrapings of mucous membranes, feces and other biomaterials can be performed, depending on the type and location of the lesion.For skin diseases, they usually perform:

  • dermatoscopy – examination of the affected areas of the skin, hair or nails to identify characteristic signs;
  • microscopic examination of scraping to detect fungal mycelium;
  • bacterial culture on nutrient media, which allows you to identify not only the type of fungi, but also the optimal drug for treatment;
  • serological blood test;
  • PCR test for detecting the genome of the fungus.

Some types of fungi are quite easily diagnosed using UV radiation, for the generation of which a Wood’s lamp is used.

Simultaneously with the determination of the type of fungus, the patient undergoes a general examination in order to identify the cause of the weakening of the immune system, which led to the infection.

Treatment

Currently, there are many tools and techniques for the treatment of almost all types of mycosis.The main method is drug therapy, which includes drugs of general action and local agents, which are selected depending on the type of fungus, the degree of damage, the duration of the disease, the patient’s health and other factors. It is best to treat mycosis of the skin and mucous membranes: if you follow the doctor’s recommendations, you can get rid of the disease within two to three weeks, and sometimes in just a few days.

In case of nail damage, the course of therapy is several months, and combined treatment is required: topical preparations are combined with systemic agents.Local dosage forms are extremely diverse: these are creams, ointments, gels, sprays, nail polishes, powders, drops. Systemic antimycotics are usually available in the form of tablets or capsules. In some cases, complete removal of the affected nail is required.

When choosing drugs, a dermatologist must take into account the individual sensitivity of the pathogen to a particular agent. The independent use of certain drugs often does not bring the desired result, since before starting treatment it is necessary to determine the type of pathogen.The diet of the patient is of great importance for certain fungal infections. So, during the treatment of yeasts and molds, it is necessary to exclude foods that contain fast carbohydrates (sweets, flour products), fermented foods, alcohol and potatoes.

Prevention

To avoid getting mycosis, you must:

  • observe hygiene rules, especially in public places;
  • avoid contact with stray animals;
  • to monitor the disinfection of instruments in hairdressing salons, beauty salons, manicure rooms;
  • Do not use other people’s clothes and shoes.

With prolonged use of antibiotics, corticosteroids and immunosuppressants, antimycotics must be taken simultaneously.

Diagnostics and treatment of mycosis in Moscow

The clinic of Medicina JSC offers reliable, comfortable and high-quality treatment of mycosis. We employ qualified dermatologists with many years of practical experience; the latest medical equipment is used for diagnostics. Modern medical procedures allow you to quickly and reliably cleanse the body of fungal infection.Call us to make an appointment, or register on our website online.

Questions and answers

Which doctor treats mycosis?

For the diagnosis and treatment of mycosis, it is necessary to contact a specialized specialist – a mycologist. However, this medical specialty is quite rare, and in the absence of such a specialist in the clinic, you should come to an appointment with a dermatologist.

Mycosis – what kind of disease and how is it dangerous?

Mycosis is a fungal infection caused by microscopic fungi.Settling on the tissues of the human body, they feed on them, while simultaneously destroying what they parasitize – skin, hair, nails, internal organs. At the same time, parasites inhibit the microflora of the body, adjust metabolic processes for themselves and poison the body with their waste products. As a result, a person constantly feels unwell, his immune system is weakened, he easily becomes infected with pathogenic viruses and bacteria, and some people even develop cancer.

How to treat mycosis at home?

There are many traditional medicine recipes for the treatment of mycoses.They can be used as an adjunct against fungus, but only with the approval of your healthcare professional. The most effective are baths and compresses with apple cider vinegar, alcohol tincture on pine cones, tea tree oil, garlic vegetable oil, birch tar, propolis. However, all these remedies alone do not completely eliminate the fungus. They are used only in combination with antimycotic medicines.

Mycosis of the skin: symptoms, causes, prevention and treatment

Contents

What is it? Terms and definitions

  1. Epidemiology
  2. Causes of the disease
  3. Transmission routes
  4. Types of disease
  5. Symptoms
  6. Diagnostics
  7. Treatment and drugs
  8. Prevention and Hygiene
  9. Conclusions

Mycoses of the skin – fungal lesions of the skin and its appendages (hair, nails) by pathogenic fungi of various types.In fact, this is a large group of diseases, united by a single criterion – the causative agent. Mycoses can manifest themselves in different ways, affect only the skin or its appendages, some are simultaneously capable of causing systemic lesions, that is, spreading their effect to internal organs. Approaches to the treatment of different mycoses also differ: something requires the use of local, topical drugs, such as ointments or creams for mycosis, something is supplemented with tablets for mycosis, oral forms of drugs of systemic action, in some cases, doctors are forced to expand the spectrum the drugs used against mycosis, in order to first achieve stabilization of the patient’s condition, and then rid him of the pathogenic fungus.

Fungal infections of the skin and nails are a common global problem. The high prevalence of superficial fungal infections shows that 20–25% of the world’s population has mycoses of the skin, mycoses of the trunk, mycoses of the feet, which makes them one of the most common forms of skin infections. Their distribution depends little on the average temperature or humidity in a particular country, on the geographical location and other reasons. Basically – from background or previous diseases, from the state of immunity, including local, from previous treatment, especially antibacterial drugs, from age, adherence to personal and public hygiene and some other factors.

The cause of mycoses is various pathogenic fungi that can live both on the skin (feet, legs, hands, arms, head, trunk) and on its appendages (head hair, body hair, nails on hands and feet). In the body of the host with mycosis, various pathological changes occur both due to the presence of an infectious agent and due to the products of its metabolism.

All mycoses can be roughly divided into three categories:

A kind of mycosis Causative agent Occurrence
Dermatophytosis Ringworm of the scalp, skin and nails Dermatophytes (Arthroderma, Lophophyton, Microsporum, Nannizzia, Trichophyton, Epidermophyton) Regular
Candidiasis of the skin, mucous membranes and nails Candida, Debaryomyces, Kluyveromyces, Meyerozyma,
Pichia, etc.
Regular
Dermatomycosis Non-dermatophytic forms
Neoscytalidium, Scopulariopsis
Rare

Ecology of common human dermatophytes:

Views Natural habitat Occurrence
Epidermophyton floccosum People Regular
Trichophyton rubrum People Frequent
Trichophyton interdigitale People Frequent
Trichophyton tonsurans People Regular
Trichophyton violaceum People Rarer
Trichophyton concentricum People Very rare
Trichophyton schoenleinii People Very rare
Trichophyton soudanense People Very rare
Microsporum audouinii People Rarer
Microsporum ferrugineum People Rarer
Trichophyton mentagrophytes Mice and other rodents Regular
Trichophyton equinum Horses Very rare
Trichophyton eriotrephon Hedgehog Very rare
Trichophyton verrucosum Cattle Very rare
Microsporum canis Cats Regular
Nannizzia gypsea The soil Regular
Nannizzia nana Soil, pigs Very rare
Nannizzia fulva The soil Very rare
Nannizzia persicolor Voles and bats Very rare
Lophophyton cookei The soil Very rare
Lophophyton gallinae Chickens and other poultry Very rare

The main source of infection is people .The main transmission path is pin . It is also possible to activate conditionally pathogenic flora in case of problems with the immune system. As fomites, that is, objects infected with pathogenic fungi, household items, shoes, clothes, bed linen of the sick person can act, if people who are sensitive to this fungus are actively in contact with them. Outbreaks are possible in organized groups, mainly in children and the army. From public places, swimming pools, water parks and other structures where people can be barefoot inside are considered a common variant of fungus infection, plus a warm and humid microclimate is formed there, contributing to the long existence of the pathogen outside the host.

In rare cases, for example, with microsporia, the source of infection can be a street or domestic animal, most often a cat. In common parlance, such a disease is called “deprivation”. “Lichen” or, more precisely, “ringworm” in a child is microsporia. Infection with trichophytosis is also possible when it comes into contact with hay or other substrates in rural areas, on which the secretions of sick rodents have remained.

In the overwhelming majority of cases, the varieties of mycoses are named by the name of the pathogen: trichophyton causes trichophytosis, microsporum causes microsporia.They differ primarily in the characteristic zones of damage.

Classification of mycoses:

Variety of mycosis Damage Area
Tinea pedis, athlete’s foot Feet
Tinea unguium, onychomycosis Fingernails and toenails
Tinea corporis Skin of hands, feet and body
Tinea cruris, athlete’s itch Inguinal folds, armpits
Tinea manuum The skin of the palms and the back of the hands
Tinea capitis Scalp skin
Tinea barbae Hair of the scalp, including scalp and face
Tinea faciei Skin on the face
Tinea versicolor, pityriasis versicolor, “sun fungus” All skin

The most common symptomatology that leads to a visit to a doctor includes nonspecific symptoms characteristic of the bulk of mycoses.This may be indicated by the following first signs:

  • Peeling and redness of the skin
  • Itching, often unbearable
  • Wetness in the folds of skin
  • Small vesicles (vesicles), bursting and drying up on their own

The rest of the symptoms of fungal diseases depend on the specific pathogen of mycosis.

Tinea pedis

There are four main clinical variants of dermatomycosis of the foot; sometimes they overlap each other in manifestations.The most common variant is intertriginous, which is characterized by cracking, peeling, or maceration of the interdigital areas; unpleasant odor; itching; and a burning sensation. The infection often affects the lateral membranes of the toes and can spread to the sole or instep. Warm and humid conditions can worsen skin conditions. The second option is the chronic papulosquamous type, which often occurs on both feet. This type is characterized by mild inflammation and diffuse scaling of the skin on the soles of the feet.The third option consists of small bubbles or pustule bubbles on the instep of the foot and the plantar surface. There is peeling of the skin in this area, as well as the membranes of the toes. The fourth option includes macerated, open weeping ulcers on the sole of the foot with a characteristic odor. This option is often complicated by opportunistic gram-negative bacteria.

Tinea corporis

It can manifest itself in different ways and on different parts of the body.Lesions often present as small, round, erythematous scaly patches. In the center, cleansing occurs as the boundaries expand and bubbles or pustules develop. Tinea corporis can occur on any part of the body, depending on the type of dermatophyte infection. Animal-transmitted zoodermatophytes often infect exposed areas of the skin, while anthropodermatophytes mostly infect closed or injured areas.

Tinea cruris

Athlete’s itch, occurs on the medial and upper thighs and groin and is more common in men than in women, and the scrotum often remains intact.Symptoms such as unbearable itching, persistent wetness and burning sensation are often present. Risk factors for this ringworm include foot dermatitis infection, obesity, diabetes, and immunodeficiency.

Ringworm of the head

The exact structure of the incidence of this form is unknown, but most often occurs in children in contact with other children or pets. There are three types of ringworm on the head: black dot, gray spot, and favus.Trichophyton often causes black punctate dermatitis on the scalp and is the predominant variant. Gray spotted dermatophytosis on the head is found in epidemic and endemic forms, but the epidemic form in developed countries is practically not recorded. The endemic form caused by microsporum is often spread by cats and dogs. Favus, more common in Eastern Europe and Asia.

The blackhead variant is often asymptomatic at first. The erythematous scaly patch on the scalp enlarges over time, and localized alopecia occurs.The hairs inside the spots break, and a characteristic black dot appears (caused by the accumulation of detritus in the follicle opening). If the blackhead fungus is left untreated, alopecia and scarring may remain permanently. Sometimes the area of ​​the lesion may change and become raised, painful, severely inflamed, with nodules known as kerion. Kerion formation is due to the immune response to the fungus. Lymphadenopathy can occur when kerion occurs. The variant with gray patches on the scalp presents as round patches of alopecia with noticeable scaling.The formation of a kerion in this case can also occur.

Onychomycosis

This type of mycosis is most often caused by dermatophytes, but it can also be caused by non-dermatophytes and Candida species. Affected nails often become thick, rough, yellow, opaque, and brittle. The nail may separate from the nail bed, and the dermis surrounding the infected nail may be hyperkeratotic. Risk factors include diabetes, trauma, family history, athlete’s foot, smoking, prolonged exposure to water, and immunodeficiency.

The diagnosis is confirmed by the detection of segmented hyphae in skin scrapings from the affected area with a preparation of potassium hydroxide (KOH). When bubbles form, the top of the bubble can be an adequate sample. Alternative diagnostic procedures are dermatophyte culture test medium and culture method.

Patients who have significant erosion, ulceration, or foul odor in the affected area should undergo Gram stain and culture to evaluate for secondary bacterial infection.

The differential diagnosis depends on the clinical subtype:

Interdigital dermatitis of the foot

  • Erythrasma
  • Interdigital candidiasis
  • Hyperkeratotic (moccasin) dermatitis of the foot
  • Atopic dermatitis
  • Chronic contact dermatitis
  • Chronic palmar-plantar (dyshidrotic) eczema
  • Palmar-plantar psoriasis
  • Pitted keratolysis
  • Juvenile plantar dermatosis
  • Exfoliating keratolysis
  • Keratoderm

Inflammatory dermatosis of the foot

  • Acute palmoplantar (dyshidrotic) eczema
  • Acute contact dermatitis
  • Palmar-plantar pustulosis
  • Scabies

A positive KOH test showing segmented hyphae distinguishes Tinea pedis from non-fungal diseases.In case of interdigital candidiasis, budding yeast, pseudohyphae and hyphae septa will be visible on the sample with the KOH preparation.

Treatment of fungal infections is recommended to relieve symptoms (itching), reduce the risk of secondary bacterial infection, and limit the spread of infection to other parts of the body or to other people. Local antifungal therapy is the treatment of choice for most patients. Systemic antifungal drugs are primarily intended for patients in whom topical therapy is ineffective.Also, systemic therapy comes to the fore in Tinea capitis, Tinea barbae, Tinea imbricata.

Topical medications that are effective for dermatophytosis include azoles, allylamines, butenafine, ciclopirox, tolnaftate, amorolfine. A meta-analysis of randomized trials published up to February 2005 confirms the efficacy of topical therapy, finding strong evidence for the superiority of topical antifungals (azoles, allylamines, ciclopirox, tolnaftate, butenafine, and undecanoate) over placebo.Allylamines may be slightly more effective than azoles; A meta-analysis of data from 11 studies comparing topical allylamines with topical azoles found a slightly higher cure rate for allylamines (odds ratio 0.63, 95% CI 0.42–0.94). Topical antifungal treatment is usually applied once or twice a day and lasts for four weeks. Shorter courses of treatment may be effective; high cure rates were obtained with 1% terbinafine cream for interdigital dermatitis of the foot for one week.

Patients requiring oral antifungal therapy are usually treated with terbinafine, itraconazole, or fluconazole. Typical adult treatment regimens include:

  • Terbinafine: 250 mg daily for two weeks.
  • Itraconazole: 200 mg twice daily for one week.
  • Fluconazole: 150 mg once a week for two to six weeks.

Griseofulvin can also be used to treat mycoses of the skin, but is likely to be less effective than other oral antifungal drugs and will also require a longer course of therapy.In a systematic review, terbinafine was found to be more effective than griseofulvin, while the effectiveness of terbinafine and itraconazole was similar. Typical doses of griseofulvin for adults with dermatomycosis of the foot are 1000 mg griseofulvin (microcapsules) per day for four to eight weeks or 660 or 750 mg griseofulvin (ultramicrocapsules) per day for four to eight weeks.

The dosage for children depends on the weight, and the duration of treatment is similar to that of an adult.Typical pediatric doses for oral therapy include:

Terbinafine tablets:

  • 10 to 20 kg: 62.5 mg per day
  • 20 to 40 kg: 125 mg per day
  • Over 40 kg: 250 mg per day

Terbinafine Granules:

  • Less than 25 kg: 125 mg per day
  • 25 to 35 kg: 187.5 mg per day
  • Over 35 kg: 250 mg per day

Itraconazole: 3 to 5 mg / kg per day.

Fluconazole: 6 mg / kg once a week.

Griseofulvin (microcapsules) 10 to 20 mg / kg per day or griseofulvin (ultramicrocapsules) 5 to 15 mg / kg per day.

The exact scheme should be selected by the attending physician in accordance with the type of lesion, the causative agent and the clinical variant of mycosis.

Patients with hyperkeratotic dermatitis of the foot may benefit from combining an antifungal treatment with a topical keratolytic such as salicylic acid.Wet dressings Burrow (1% aluminum acetate or 5% aluminum subacetate) applied for 20 minutes two to three times a day, or applying gauze or cotton between the toes, may be helpful as an adjunct measure for patients with vesiculation or maceration. Interventions that can help reduce relapse include using dehydrating foot powders, treating shoes with antifungal powder, and avoiding tight shoes.

If someone in your home has or has had a fungal infection on the skin:

  • Get rid of combs, brushes, hairpins, or other hair products that may have fungus.Do not use other items of the sick person that may have come into contact with their skin.
  • Make sure a doctor checks everyone in the house for fungal infections.
  • If the fungal infection could be caused by a pet, see your veterinarian.

Here are some more general tips on how to prevent fungal infections:

  • Do not share unwashed clothing, sports equipment, or towels with other people.
  • Always wear slippers or sandals when in the gym, pool, or other public places. This includes public showers.
  • Wash your face with soap and shampoo after sports or exercise.
  • Change your socks and underwear at least once a day.
  • Keep your skin clean and dry. Always dry yourself well after bathing or showering.

Superficial fungal infections are most commonly caused by dermatophytes from the genera Trichophyton, Epidermophyton, and Microsporum.These organisms metabolize keratin and cause a number of pathological clinical manifestations, including dermatomycosis of the foot, dermatophytal dermatitis, dermatophytosis, etc. On the basis of clinical data, the diagnosis of dermatophyte skin infection can be seriously suspected. A potassium hydroxide preparation should be used to confirm the diagnosis. Most dermatophyte infections can be managed with topical treatments. Examples of effective topical antifungal agents are azoles, allylamines, ciclopirox, butenafines, and tolnaftate.Oral antifungal therapy is used for extensive infections or infections that are resistant to topical therapy. Nystatin is not effective for dermatophyte infections.


References / References

  1. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide // Mycoses. 2008 Sep; 51 Suppl 4: 2-15. doi: 10.1111 / j.1439-0507.2008.01606.x. Erratum in: Mycoses. 2009 Jan; 52 (1): 95. PMID: 18783559.
  2. Havlickova B, Czaika VA, Friedrich M.Epidemiological trends in skin mycoses worldwide // Mycoses 2008; 51 Suppl 4: 2.
  3. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections // Mycopathologia 2008; 166: 335.
  4. Ameen M. Epidemiology of superficial fungal infections // Clin Dermatol 2010; 28: 197.
  5. El-Gohary M, van Zuuren EJ, Fedorowicz Z, et al. Topical antifungal treatments for tinea cruris and tinea corporis // Cochrane Database Syst Rev 2014; : CD009992.
  6. Alston SJ, Cohen BA, Braun M. Persistent and recurrent tinea corporis in children treated with combination antifungal / corticosteroid agents // Pediatrics 2003; 111: 201.
  7. Greenberg HL, Shwayder TA, Bieszk N, Fivenson DP. Clotrimazole / betamethasone diproprionate: a review of costs and complications in the treatment of common cutaneous fungal infections // Pediatr Dermatol 2002; 19:78.
  8. Rosen T, Elewski BE. Failure of clotrimazole-betamethasone dipropionate cream in treatment of Microsporum canis infections // J Am Acad Dermatol 1995; 32: 1050.
  9. Hawkins DM, Smidt AC. Superficial fungal infections in children // Pediatr Clin North Am 2014; 61: 443.
  10. Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot // Cochrane Database Syst Rev 2007; : CD001434.
  11. Korting HC, Tietz HJ, Bräutigam M, et al. One week terbinafine 1% cream (Lamisil) once daily is effective in the treatment of interdigital tinea pedis: a vehicle controlled study. LAS-INT-06 Study Group // Med Mycol 2001; 39: 335.
  12. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis // Mycopathologia 2008; 166: 353.
  13. Bell-Syer SE, Khan SM, Torgerson DJ. Oral treatments for fungal infections of the skin of the foot // Cochrane Database Syst Rev 2012; 10: CD003584.
  14. Adams BB. Tinea corporis gladiatorum // J Am Acad Dermatol 2002; 47: 286.
  15. van Zuuren EJ, Fedorowicz Z, El-Gohary M. Evidence-based topical treatments for tinea cruris and tinea corporis: a summary of a Cochrane systematic review // Br J Dermatol 2015; 172: 616.6.
  16. Bourlond A, Lachapelle JM, Aussems J, et al. Double-blind comparison of itraconazole with griseofulvin in the treatment of tinea corporis and tinea cruris // Int J Dermatol 1989; 28: 410.
  17. Cole GW, Stricklin G. A comparison of a new oral antifungal, terbinafine, with griseofulvin as therapy for tinea corporis // Arch Dermatol 1989; 125: 1537.
  18. Panagiotidou D, Kousidou T, Chaidemenos G, et al. A comparison of itraconazole and griseofulvin in the treatment of tinea corporis and tinea cruris: a double-blind study // J Int Med Res 1992; 20: 392.
  19. Faergemann J, Mörk NJ, Haglund A, Odegård T. A multicenter (double-blind) comparative study to assess the safety and efficacy of fluconazole and griseofulvin in the treatment of tinea corporis and tinea cruris // Br J Dermatol 1997; 136: 575.
  20. Elewski BE, Hughey LC, Sobera JO. Fungal diseases. In: Dermatology, 3rd ed, Bolognia JL, Jorizzo JL, Schaffer JV (Eds), Elsevier Limited, Philadelphia; London 2012. Vol 2, p. 1251.
  21. Voravutinon V. Oral treatment of tinea corporis and tinea cruris with terbinafine and griseofulvin: a randomized double blind comparative study // J Med Assoc Thai 1993; 76: 388.
  22. Farag A, Taha M, Halim S. One-week therapy with oral terbinafine in cases of tinea cruris / corporis // Br J Dermatol 1994; 131: 684.
  23. Smith KJ, Neafie RC, Skelton HG 3rd, et al. Majocchi’s granuloma // J Cutan Pathol 1991; 18:28.
  24. Gill M, Sachdeva B, Gill PS, et al. Majocchi’s granuloma of the face in an immunocompetent patient // J Dermatol 2007; 34: 702.
  25. Cho HR, Lee MH, Haw CR. Majocchi’s granuloma of the scrotum // Mycoses 2007; 50: 520.
  26. Tse KC, Yeung CK, Tang S, et al. Majocchi’s granuloma and posttransplant lymphoproliferative disease in a renal transplant recipient // Am J Kidney Dis 2001; 38: E38.
  27. Kim ST, Baek JW, Kim TK, et al. Majocchi’s granuloma in a woman with iatrogenic Cushing’s syndrome // J Dermatol 2008; 35: 789.
  28. Akiba H, Motoki Y, Satoh M, et al. Recalcitrant trichophytic granuloma associated with NK-cell deficiency in a SLE patient treated with corticosteroid // Eur J Dermatol 2001; 11:58.
  29. Ilkit M, Durdu M, Karakaş M. Majocchi’s granuloma: a symptom complex caused by fungal pathogens // Med Mycol 2012; 50: 449.
  30. Novick NL, Tapia L, Bottone EJ. Invasive trichophyton rubrum infection in an immunocompromised host. Case report and review of the literature // Am J Med 1987; 82: 321.
  31. Feng WW, Chen HC, Chen HC. Majocchi’s granuloma in a 3-year-old boy // Pediatr Infect Dis J 2006; 25: 658.
  32. Gupta AK, Prussick R, Sibbald RG, Knowles SR.Terbinafine in the treatment of Majocchi’s granuloma // Int J Dermatol 1995; 34: 489.
  33. McMichael A, Sanchez DG, Kelly P. Folliculitis and the follicular occlusion tetrad. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Elsevier Limited, St. Louis 2008.
  34. Gupta AK, Groen K, Woestenborghs R, De Doncker P. Itraconazole pulse therapy is effective in the treatment of Majocchi’s granuloma: a clinical and pharmacokinetic evaluation and implications for possible effectiveness in tinea capitis // Clin Exp Dermatol 1998; 23: 103.
  35. Burg M, Jaekel D, Kiss E, Kliem V. Majocchi’s granuloma after kidney transplantation // Exp Clin Transplant 2006; 4: 518.
  36. Liao YH, Chu SH, Hsiao GH, et al. Majocchi’s granuloma caused by Trichophyton tonsurans in a cardiac transplant recipient // Br J Dermatol 1999; 140: 1194.
  37. Bonifaz A, Vázquez-González D. Tinea imbricata in the Americas // Curr Opin Infect Dis 2011; 24: 106.
  38. Cheng N, Rucker Wright D, Cohen BA. Dermatophytid in tinea capitis: rarely reported common phenomenon with clinical implications // Pediatrics 2011; 128: e453.
  39. Romano C, Rubegni P, Ghilardi A, Fimiani M. A case of bullous tinea pedis with dermatophytid reaction caused by Trichophyton violaceum // Mycoses 2006; 49: 249.
  40. Al Aboud K, Al Hawsawi K, Alfadley A. Tinea incognito on the hand causing a facial dermatophytid reaction // Acta Derm Venereol 2003; 83:59.
  41. Veien NK, Hattel T, Laurberg G. Plantar Trichophyton rubrum infections may cause dermatophytids on the hands // Acta Derm Venereol 1994; 74: 403.

Fungal diseases, how to protect yourself? Blog ON Clinic

Fungal diseases are as common as colds. They are dangerous not only for health, but also for human life.

Mushrooms live everywhere: in the soil, in the air and even in the human body. They cannot be detected with the naked eye due to their microscopic size. With the onset of favorable conditions, they are able to quickly multiply and parasitize. For the most part, fungal infections can seriously threaten the health of those with weakened immune systems.For example, prolonged onychomycosis (fungal infection of the feet and nails) can lead to an exacerbation of chronic diseases.

Dermatologist of the ON Clinic Poltava medical center Yekaterina Manzhula says:

“Fungus is not just a problem that causes certain inconveniences. This is a serious parasitic infection of the body, capable of acting as a catalyst for all inflammatory processes of internal organs and systems. And, first of all, the fungus weakens the immune system ”.

The number of fungal infections is increasing every year. One of the reasons for what is happening, scientists say the increase in the number of HIV-infected people and those who suffer from other immune diseases.

The most common parasitic fungi are those of the genus Cryticiccus neoformans, Sandida albicans, Mucoraceae sp. They are capable of parasitizing the skin, hair, nails, as well as affecting the internal organs and systems of a person.

According to doctors of medical sciences of the Lviv Medical University, for every 10 cells of the human body there are 2 times more bacteria, fungi and viruses of various origins.As long as a person is healthy, including good nutrition, the risk of infection is low. According to official figures, 15-40% of healthy people are carriers of fungal infections and can infect others. As a rule, mucous membranes, skin, nails and even blood are considered to be the favorite places for the deployment of fungi.

I will add: both useful and conditionally pathogenic (capable of being activated only when a favorable environment comes) and pathogenic fungi “live” in the human body. If their number is normal (balance is maintained) and this rate is under control of a healthy organism, they are not capable of causing serious harm.

Fungi on the skin and nails

Fungi that affect the skin and nail plates are most easily transmitted. Among the most common diseases, dermatologists note mycoses – a group of diseases that infect the skin, hair and nails. It is these parts of the body that every second are in close contact with the environment rich in mycotic pathogens (dermatophytes, trichophytos, yeasts of the genus Malassezia). Most often, people encounter interdigital mycoses, dermatomycosis of the hair, feet and skin due to direct contact with infected objects (towels, bedding, clothes), as well as due to close contact with infected people or animals.

The symptoms of mycosis include redness, peeling, itching in the area of ​​the nail, skin folds on the body, scalp, feet. If you find such symptoms, contact a dermatologist immediately.

Observance of basic hygiene rules, use of your things and accessories in public places (baths, saunas, swimming pools) will help protect yourself from fungus. If you visit a manicurist or hairdresser, make sure that his workplace and tools are sterile. If you find violations, do not agree to the procedure.If a member of your family is already infected, it is necessary to carefully disinfect the shared areas (bath, toilet) with disinfectants, wash the bed linen and clothes of the infected person separately from their belongings.

Fungi in the genitals

Fungi of the genus Candida are present in small quantities in the female and male body. In women and men, they can cause candidiasis (thrush): in the weaker sex, the vagina is affected, and in the strong, the foreskin, the head of the penis.Most often, Candida is activated against the background of weakened immunity, due to prolonged use of antibiotics, a sharp change in climate, against the background of metabolic disorders. The symptoms of the disease are burning and itching in the genital area, pain during urination, uncharacteristic discharge.

Gynecologist of the ON Clinic Kharkiv medical center Alla Braslavets notes:

“Frequent stress greatly reduces the protective functions of the body, which many forget. If there is a fungal infection in such an organism, including those from the genus Candida, the fungi begin their attack without obstacles ”.

Fungi in children

In children, most often fungi of the genus Candida affect the oral cavity and can cause candidiasis or stomatitis of the oral cavity (the formation of white ulcers and plaque on the mucous membranes). Even newborns can develop a fungal infection. I will say that the cause of the development of a fungal infection in this case may be:

  • improper feeding;
  • Insufficient sterilization of nipples, teethers or baby dishes;
  • a formed habit of the baby to take in his mouth all objects that come to hand.

In older children, thrush is most often activated against the background of reduced immunity and trauma to the oral cavity.

Pediatrician of the children’s department of the medical center “ON Clinic Kharkov Palace of Sports” Tatiana Sirbu advises:

“Treatment of fungal infections in adults and children is based on the use of antifungal drugs, general strengthening procedures, a special diet (refusal yeast products, fatty and smoked dishes) and hygiene.And, of course, the doctor should select the treatment regimen, based on what kind of fungus parasitizes in the body. ”

Fungus in internal organs

The gastrointestinal tract and genitourinary tract can also be affected by the pathogenic effects of a fungus, usually of the genus Candida. In most cases, candidiasis of the gastrointestinal tract develops against the background of uncontrolled intake of antibiotics, due to serious disorders of the immune system, as well as due to ingestion of contaminated foods (for example, due to unwashed vegetables and fruits).But candidiasis of the genitourinary tract can appear due to diabetes mellitus, surgery, or the presence of drainage in the urinary tract. Also, the cause of damage to the genitourinary system of a fungal infection is a decrease in immunity.

And there are also very dangerous fungi. For example, the fungus Blastomyces dermatitidis can be airborne and, if ingested during respiration, can cause blastomycosis. This is a lung disease that can translate into acute respiratory failure.

No less dangerous is Sporothrix schenckii, which lives on bushes of roses, barberry and other horticultural crops. The fungus enters the skin of a person through small scratches or cuts and causes sporotrichosis, a rare skin infection that most often affects the face, hands and feet.

Can you protect yourself from fungi?

Of course! Our body has its own microorganisms that are able to maintain immunity, but can be destroyed by drugs.In most cases, self-medication leads to this. In order not to become hostages of mushrooms, strengthen the immune system, observe the rules of hygiene and timely undergo scheduled examinations by therapists, dermatologists, gynecologists and urologists. If already infected, start treatment immediately.

Don’t let the Mushroom Corporation become the masters of your body!

Article rating:

5 out of 5 based on 1 rating

Author:
Natalia Pavlova

Beethoven – veterinary clinic, Krasnoyarsk

Malassezia pachydermatis is a common yeast that is normally found on the skin and ear canal of healthy dogs and cats.Under certain conditions, this fungus begins to multiply and can lead to illness. This fungus is not contagious to humans and other animals. Since it is part of the normal microflora of the skin, it begins to multiply vigorously only if conditions permit. The increased reproduction of this fungus is usually secondary to some other disease that has changed the microclimate of the skin. He usually likes moisture, warmth, and sore skin. Dogs of “folded” breeds are predisposed. The primary diseases that predispose to yeast infection are allergies, hormonal disorders, and decreased immunity.

Signs – Malassezionny otitis media can be localized or generalized, and is usually accompanied by itching. Itching can vary in degree from mild to very severe. The affected skin usually turns red, often thickens and darkens. The most common areas of this disease are ears, groin, interdigital space, neck, under

barbs, armpits, folds of skin (muzzle, tail). An unpleasant odor from the affected skin may be noticeable.

Diagnosis – Malassezionny dermatitis is diagnosed by cytology – examination of stained preparations from the skin or from snakes, in which an increased amount of these fungi is found on the skin. Several individual fungi in the sample are normal, so culture has no diagnostic value. More than 1-2 fungi in the field of view of the microscope indicate an increased number. Sometimes you can find dozens in one field of view.

Treatment – Treatment of malassezional dermatitis or otitis media is performed using topical and / or systemic antifungal agents.Some cases are difficult to treat. It is important to continue treatment until the cytology is free of fungi. Usually the course of treatment lasts 30-45 days, but in some cases it may take longer

nd course.

It is necessary to try to find out the root cause of the disease. In cases where this cannot be done, or the underlying disease does not respond to treatment, a relapse of malassezional dermatitis may occur. In such cases, long-term maintenance therapy may be required.

Foot fungus | STADA

Foot fungus

Many people face a fungal infection and usually there is nothing terrible in it, but it can be difficult to recover.

Infection in 30% of cases occurs from a family member with mycosis.Most often, the infection is transmitted through shared shoes: small skin scales, on which the fungus is located, fall into, say, slippers – and the person puts them on after the patient. Therefore, in stores, shoes are allowed to be measured only in stockings or socks.

At home, you can also get infected through other household items: rugs, towels, washcloths. With equal frequency, it is possible to pick up the fungus in public places: in saunas, showers, gyms, swimming pools and even on the beach.

Why is mycosis of the foot dangerous?

The danger of infection lurks in any place where people go barefoot.The spores of the fungus can withstand both high (up to 100 ° C) and low (up to minus 50-60 ° C) temperatures, and remain active for months in the beach sand. (It is not for nothing that they recommend walking there in slippers, and not barefoot!).

Those people who have broken the integrity of the skin, have cracks, ulcers, erosion are at risk. Patients suffering from impaired blood supply to the legs should also be especially clean and vigilant.

Varieties of mycosis of the feet

  1. The intertriginous form is the most typical, manifested by lesions of the skin of the interdigital folds: redness, cracks, maceration (softening, swelling) of the epidermis, peeling.It is accompanied by itching and burning. The dorsum of the foot, as a rule, remains unaffected, but hyperemia and peeling may be present on the sole. With this form of mycosis of the feet, the addition of a secondary (bacterial) infection often occurs.
  2. The squamous hyperkeratotic form is manifested by diffuse or focal thickening of the stratum corneum (hyperkeratosis) of the lateral and plantar surfaces of the feet, which bear the greatest load. Usually, the affected areas of the skin have a mild inflammatory color and are covered with small scaly or flour-like scales.The altered foot can be in the form of a “underfoot” or – a “moccasin type”. Peeling in the skin furrows creates an exaggerated pattern, which gives the skin a “powdered” look. Subjectively, dry skin, moderate itching, and sometimes soreness in the affected area are noted.
  3. Dyshidrotic form is characterized by the appearance of painful, itchy vesicular rashes, which merge with each other and form multi-chambered blisters. Subsequently, bubbles and bubbles break open with the formation of extensive erosion.In its clinical manifestations, this form of mycosis resembles foot eczema.
  4. With the erased form of mycosis of the feet, minimal clinical manifestations are observed in the form of mucous peeling and microcracks in the interdigital folds of the skin between the first and second and / or fourth and fifth toes. This form is rarely accompanied by subjective symptoms and often goes unnoticed for patients.

If you have unpleasant odors and itchy feet, see your doctor.

Safety precautions

By following simple precautions, the risk of contracting a fungus can be significantly reduced.

  • Do not go barefoot where there is a risk of infection. When using the shower in a hotel, hostel, swimming pool, or at work, be sure to wear rubber slippers.
  • If you have injured your skin or nail, do not go to saunas and swimming pools until complete healing. If, nevertheless, there was contact with “doubtful” surfaces, after which itching appeared in the area of ​​the wound, and redness increased, use Fungoterbin NEO.
  • Never lend to someone and, of course, don’t put on other people’s slippers, stockings, socks. Do not use other people’s towels, pedicure and manicure tools.
  • In the pedicure office, urge the master to wash hands and disinfect instruments after a previous client.
  • Wash your feet twice a day (morning and evening). And after that, wipe them thoroughly, especially between your fingers. If you cannot dry the narrow interdigital spaces with a towel, use cotton swabs or even a hair dryer.For prevention, treat the interdigital area with talcum powder.
  • Change socks, stockings, tights daily. All such items must be cotton or other natural materials.
  • Give preference to shoes made only of genuine leather or fabric. In addition, in no case should it be too narrow, let alone tight.

Treatment of mycoses of the feet

The earlier the treatment starts, the higher the chance of cure. When prescribing drugs, first of all, external antifungal agents are prescribed, which are applied directly to the affected skin.

Treatment of mycosis of the foot begins with the removal of keratinized tissue, removal of the restoration and suppression of the infection with antifungal agents (in some cases, antibacterial agents may be required). The use of combined external antifungal agents with a high urea content has a more pronounced therapeutic effect. Urea softens the stratum corneum and has a high dermatopenetrance (penetration into the skin), which makes it possible to create high concentrations of the antifungal agent in the focus of fungal infection.

Related products

Other articles

Nail fungus

Nail fungus (onychomycosis) is a common disease caused by various types of parasitic fungi.

90,000 Veterinary clinic Dog and Cat in St. Petersburg

Mushrooms of the genus Malassezia (Malassezia) are representatives of the normal microflora of the skin and mucous membranes of most warm-blooded animals and humans.

Normally, the relationship of fungi of the genus Malassezia and the animal is symbiotic. Living on healthy skin, yeast consumes fat-like substances contained in skin secretions, and, in turn, synthesizes antibacterial and antifungal substances that prevent the development of other pathogenic microorganisms on the skin.

Carriage of Malassezia fungus is widespread in clinically healthy animals. They can be found in the auditory canal, rectum, anus, perianal glands, interdigital spaces.

However, sometimes, for various reasons, the body begins to produce more natural secretions (increased production of secretion of the sebaceous glands of the skin, increased production of earwax, trauma to the mucous membranes and skin) – then there is an increased growth of malassezia, and we are faced with “malassezionny dermatitis”.

Malassezionny dermatitis of dogs and cats is usually secondary to other conditions.

The contributing factors are:

  • allergic reactions
  • bacterial skin infections
  • endocrine disorders.

Prolonged contact of the animal’s paws with chemicals (asphalt pavement), poor grooming of the hair and physiological folds, the presence of long and dirty hair contributes to a violation of air exchange and an increase in humidity. All this also creates a good environment for the development of Malassezia.

Clinical signs in dogs

Malassezia dermatitis in dogs is manifested by:

  • otitis externa
  • itchy
  • erythema (redness of the skin)
  • peeling
  • alopecia (hair loss).

With a chronic process:

  • skin thickening, wrinkling and roughness (lichenification of the skin)
  • Deposition of pigment in the superficial layers of the skin (hyperpigmentation).

The auricles, lips, muzzle, ventral (front) neck, feet, underarms, inner paws, and the area around the anus are often affected.

Malassezia can also cause paronychia (inflammation of the periungual ridge) with a wax-like discharge and discoloration of the nails.

Clinical signs in cats

Itching is less common in cats with malassezium dermatitis. Clinical symptoms include:

  • otitis externa
  • feline acne
  • seborrheic and scaly facial dermatitis
  • generalized desquamation and erythema
  • paronychia with discoloration of claws.

Diagnostics

Since the clinical signs of malassezium dermatitis are nonspecific and characteristic of many other dermatological problems, more research is required.Most often, the doctor needs to exclude the following diagnoses causing the same symptoms:

  • parasitic diseases (sarcoptic mange, demodicosis, heiletiosis, etc.)
  • bacterial infections
  • neoplasms
  • allergies.

All of these diseases can occur in parallel with dermatitis caused by malassezia.

Diagnosis is based on clinical symptoms, cytology, skin scrapings, and fingerprints.

Treatment

When treating malassezia dermatitis, it is necessary to identify the main predisposing factor responsible for the development of mycosis. Otherwise, without an accurate diagnosis, the animal will suffer from constant relapses. In addition, the same malassezionny dermatitis requires different therapy, depending on the underlying cause of the disease:

With concomitant bacterial infections, appropriate antibiotic therapy (local or systemic) is prescribed.Corticosteroids and allergy control medications are used to relieve symptoms of an allergic reaction.

To destroy the yeast culture, both systemic and local treatment is carried out. Apply creams and shampoos containing antiseptics or antifungal components.