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Case Note

Case Note: Painful Erosions


A 42-year-old healthy female works as a dishwasher, but does not wear gloves. She presents for evaluation and management of painful erosions on the hands and nail-fold changes over several weeks.

Initial evaluation

  • Healthy-appearing female
  • On bilateral hands, there are brightly erythematous fissured erosions in the interdigital web spaces between fingers, in addition to edema and erythema of the proximal nail folds of several digits
  • KOH preparation of fluid taken from an eroded fissure reveals pseudohyphae and yeast forms



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Enter your diagnosis


  • A diagnosis of candidiasis (erosio interdigitalis blastomycetica and paronychia) is rendered

Initial Treatment

  • Recommendation:
    • Nystatin ointment b.i.d. to interdigital web spaces
    • Nystatin ointment mixed in equal parts with topical corticosteroid triamcinolone 0.1% ointment b.i.d. to the proximal nail folds
  • Skin care reviewed: to keep skin dry by wearing protective gloves when exposing hands to water
  • Follow up in 4 weeks

Follow-up evaluation strategy

  • Erosions of the interdigital web spaces are completely cleared
  • Paronychia of multiple fingers is greatly improved; ongoing treatment is recommended

General discussion

Candidiasis typically affects mucosal sites and moist and/or occluded areas of skin: groin, axilla, inframmary, infra-abdominal pannus, glans penis (in uncircumcised males), and orogenital mucosal sites.

Predisposing factors include obesity, diabetes, antibiotic or corticosteroid treatments, immunosuppression, removable prostheses, and chronic or frequent exposure to moisture, including saliva, fecal and urinary incontinence.

Candidal superinfection may complicate pre-existing cutaneous diseases, as abnormal skin may predispose to candidal overgrowth. Failure of standard anticandidal treatment to fully clear symptoms should raise suspicion for an underlying or coexisting disease.

Further reading

Giannini PJ, Shetty KV. Diagnosis and management of oral candidiasis. Otolaryn Clin N Amer. 2011;44:231-240.

Wolf R, Oumeish OY, Parish LC. Intertriginous eruption. Clinics Derm. 2011;29:173-179.


Disclaimer: The material above has been adapted from Therapeutic Strategies prepared by It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.