Candidal intertrigo

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

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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].

 

Related Information

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):569-573. PubMed.

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