Saturday, January 01, 2011
Candida albicans causes cutaneous disease in occluded,
moist areas: the groin, axilla, inframammary areas, and the glans
penis (in uncircumcised males). Diabetes, obesity, fecal and
urinary incontinence, and immunosuppression are predisposing
factors. The therapeutic strategy is to eliminate the pathogenic
organism and to correct the factors that predispose the patients to
- If the skin is weeping, instruct the patient to soak in dilute
Burow's solution 1: 20 (1 tablet in a pint of water) twice daily
for 15 minutes.
- Prescribe nystatin ointment applied three times daily or an
imidazole cream (eg, clotrimazole, Nizoral or Spectazole, but not
oxiconazole) applied twice daily to the affected area. If erosive
lesions are present, the cream may cause burning.
- Instruct the patient to dry the moist areas by exposing them to
the air, and if appropriate, to keep stool and urine away from the
- Look for associated yeast vaginitis in cases of vulvar
candidiasis in women.
- If other risk factors are present (obesity, family history,
symptoms, risk factors) evaluate the patient for diabetes mellitus
and immunosuppression, especially HIV infection.
- Nystatin ointment or zinc oxide paste applied over the topical
imidazole may enhance therapy by providing a protective barrier
from sweat, urine, and stool.
- Adding hydrocortisone 1% ointment to the anticandidal agent
will speed healing and reduce symptoms more rapidly.
- Men with balanitis may have partners with candidal vaginitis;
the sexual partner also needs treatment.
- Although cosmetically unattractive, gentian violet solution
twice daily for 3 days is drying and has good anticandidal
- For severe unresponsive cases, oral fluconazole 150-200 mg/day
for 1 week is of benefit.
- Preventive therapy includes keeping the area dry by wearing
loose-fitting underwear and using topical drying bland powders (eg,
talc) or an imidazole-containing powder (eg, miconazole
- Do a KOH preparation prior to therapy to establish the
- Secondary bacterial infection may require systemic
- Avoid applying solutions to inflamed skin, as they will cause
- Refractory lesions may need a biopsy to rule out extramammary
Paget's disease, squamous cell carcinoma in situ (Bowen's
disease), and metabolic and other inflammatory causes of an