This summary is an overview of local mucocutaneous candidiasis. Local mucocutaneous candidiasis refers to a variety of infections caused by Candida albicans (in 70%-80% of cases) or any of the 200 other yeasts in this genus involving skin and mucous membranes. Candida albicans is also a normal commensal and colonizes the oropharynx of up to 50% of asymptomatic people. The clinical presentations of local mucocutaneous candidal infection include thrush, or oral candidiasis, Candidaepiglottitis and esophagitis, vaginal and vulvovaginal candidiasis, generalized cutaneous candidiasis, intertrigo, erosio interdigitalis blastomycetica, Candida miliaria, and Candida of the genitalia, including candidal balanitis and perianal skin. Paronychia and onychomycosis, diaper dermatitis, and chronic mucocutaneous candidiasis are also part of the mucocutaneous syndromes.
Mucous membrane infections:
Thrush, or oral candidiasis, is normally seen in infants younger than 1 year or older than 12 years but can be seen in children on medications such as antibiotics or chemotherapy, in immunodeficient children, or in asthmatic patients who take inhaled steroids. The infection manifests as white plaques on the lips, tongue, and palate that bleed on superficial scraping.
Vulvovaginitis occurs commonly in pubertal and postpubertal girls and can arise due to antibiotic or corticosteroid therapy or in adolescent girls who are taking oral contraceptives. Patients complain of pruritus and discharge along with dysuria and dyspareunia in sexually active girls.
Generalized cutaneous candidiasis: This appears as deep red skin that is edematous and oozing fluid. Crusting and pustular lesions are present as "satellite" lesions. The presence of plaque formation may cause this condition to resemble psoriasis. Infected skin may be localized or widespread, and sometimes the scalp may be affected with resultant hair loss.
Diaper dermatitis: Candidal diaper dermatitis develops when sufficient moisture in the diaper area allows C albicans to proliferate and invade the stratum corneum. Children may experience burning on micturition.
Intertrigo: This form of candidiasis is more prevalent in obese or diabetic children. Intertrigo commonly occurs in the axillary region, intergluteal cleft, inguinal folds, and other body folds. Patients frequently feel itchy in these areas. Predisposing factors include moisture, heat and maceration, obesity, and tightly fitting clothing. The skin presents with red erythematous macules with surrounding satellite lesions.
Erosio interdigitalis blastomycetica: In erosio interdigitalis blastomycetica, children may develop candidal infection of the web spaces of their fingers or toes if they are constantly moist or remain immersed in water for a long period of time.
Candidal folliculitis: Folliculitis is infection of the hair follicles. Although usually localized, it may become widespread and must be differentiated from folliculitis caused by dermatophytes and tinea versicolor.
Male genital candidal infection: Genital candidal infection in boys can manifest as either balanitis or as erythema of the scrotal area or penile shaft.
Chronic mucocutaneous candidiasis: Chronic mucocutaneous candidiasis is a genetic syndrome linked to defective cell-mediated immunity to Candida antigens in which children experience recurring candidal infections. Chronic skin lesions appear as hyperkeratotic crusted lesions and nail dystrophy. The affected nails are thickened, brittle, and yellow-brown in color and have associated paronychia. Most cases develop in childhood and adolescence.
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Candidiasis, commonly known as a yeast infection, is an infection with the common yeast (or fungus) organism, Candida albicans, which is commonly found in the environment. Sometimes this yeast lives in the mouth, digestive (gastrointestinal) tract, and the vagina, along with many kinds of harmless bacteria, without causing any issues. However, under certain conditions (particularly weakening of the immune system, the use of antibiotics, exposure to cancer drugs or corticosteroids, or in diabetics), the fungus will multiply and cause disease.
There are different forms of yeast infection, depending upon the area affected. Most commonly, the mouth, vagina, and damper skin areas are affected, as the yeast likes to grow in moist areas.
Most yeast infections are on the surface (superficial) and easily treated; however, serious life-threatening yeast infection can develop throughout the body (systemic) in people with very weak immune systems.
Who’s At Risk
Various species of Candida yeast grow in over half of healthy adults.
Men and women are affected equally.
People with weakened (suppressed) immune systems, who use antibiotics, take cancer drugs or corticosteroids, or are diabetic are more likely to develop a yeast infection.
Older people are more likely to get thrush (oral candidiasis).
In women, yeast infection is the second most common cause of inflammation of the vagina (vaginitis).
Long-lasting (persistent) symptoms and yeast infection that does not heal may be the first sign of infection with HIV.
Signs & Symptoms
The appearance and symptoms of yeast infection depend upon the area affected.
The most common types of infection are:
Thrush (oral yeast infection) - The mouth lining, tongue, and/or angles of the mouth are red, cracked, or have white patches. There may be soreness or no symptoms. This is discussed separately.
Skin (cutaneous) - Small-to-large patches of red, moist, raw skin usually develop in body creases, such as under the breasts, belly, or groin area. The skin may itch or be painful. Tiny pus-containing lesions (pustules) may appear around the edges of the red areas.
Vaginitis - Vaginal itch, pain, or burning are frequent and may be accompanied by a cottage-cheese-like discharge. There is usually pain with sexual intercourse.
Esophagitis - Swallowing may be painful, and there may be pain behind the breastbone.
Self-Care Guidelines
Most yeast infections can be prevented by keeping body-fold areas clean and dry.
Diabetics should keep their blood sugar under good control.
Treat skin infection with a combination of an over-the-counter antifungal cream (such as clotrimazole or miconazole twice daily for 10-14 days) with hydrocortisone cream (0.5-1% applied twice daily after the antifungal cream).
Lose weight if you are overweight.
A NON-pregnant women can treat vaginitis with an over-the-counter vaginal suppository or cream antifungals (miconazole or clotrimazole). The woman's partner does not normally need treatment. Avoid sexual intercourse until the yeast infection heals.
When to Seek Medical Care
See your doctor if your symptoms do not go away with self-care.
Remember that vaginitis can be caused by something other than yeast infection, and you might have a sexually transmitted disease if you are sexually active. See your doctor to confirm the diagnosis.
Treatments
Your doctor may prescribe oral antifungal medications for any form of yeast infection that does not improve with self-care measures.
References
Bolognia, Jean L., ed. Dermatology, pp.1110-1111, 1185, 1837. New York: Mosby, 2003.
Patient Information for Candidiasis in Child