EACH TYPE of CUTANEOUS CANDIDIASIS
In the skin the most common site is in the skin folds also called Candida intertrigo .
This is seen under pendulous breasts between overhanging abdominal folds in the groin and rectal area and in the axillae.
Type A:- Why more common at Skin folds ?? contains heat and moisture providing the environment suited for yeast infection. Hot humid weather tight or abrasive underclothing poor hygiene and inflammatory diseases occurring in the skin folds such as psoriasis make a yeast infection more likely in the axillae.
Skin folds contains heat and moisture providing the environment suited for yeast infection. Hot humid weather tight or abrasive underclothing poor hygiene and inflammatory diseases occurring in the skin folds such as psoriasis make a yeast infection more likely
Type A:--INTERTRIGO
Obese people are at greatest risk. Itching burning and stinging are the most common symptoms apposing skin folds retain moisture and become warm macerated and inflamed,, Candida is the most common secondary infection but bacteria fungi or viruses may be a factor . Erosions are possible Sweat feces urine and vaginal discharge may aggravate intertrigo . The course can be recurrent and chronic.
CLINICAL FEATURES
There are two presentations In the first type pustules form but become macerated under apposing skin surfaces and develop into red papules with a fringe of moist scale at the border. Intact pustules may be found outside the opposing skin surfaces.
CUTANEOUS CANDIDIASIS(contd):
2) Type B:-The second type consists of a red moist glistening plaque that extends to or just beyond the limits of the opposing skin folds. The advancing border is long and sharply defined and has an ocean wave shaped fringe of macerated scale. The characteristic pustule of candiadiasis is not observed in intertriginous areas because it is macerated as soon as it forms .Pinpoint pustules do appear outside the advancing border and are an important diagnostic feature. There is a tendency for painful fissuring in the skin creases.
TREATMENT
A) General Measures
Education about the role of moisture and maceration is important . The following techniques may be recommended drying affected areas after bathing using a hand held hair dryer on low heat at least once a day . Supportive clothing and weight reduction air conditioning in warm environments and regular application of a plain or medicated powder to the areas.
For very inflammatory lesions open compresses three to four times a day with water or normal saline will expedite relief of symptoms. Cool water compresses applied for ½ hour two or three times a day for just a few days are rapidly effective in controlling moisture and suppressing inflammation.
B) Topical Agents
A 1 or 2 week course of group VI to VII topical steroids may be all that is necessary . long term continuous use of topical steroids in skin fold areas may result in atrophy and striae 0.1% tacrolimus may be used as an anti inflammatory agent instead of topical steroids for initial treatment or for cases requiring long term intermittent treatment Ciclopirox cream or lotion twice daily for 1-2 weeks or until resolved is another option . It is a good practice to add a topical anti yeast medication, such as miconazole creams with topical steroids. To separate and expose skin effectively in order to promote dryness administer while the patient is in the supine position. After clinical resolution topical antifungal treatments may be continued twice weekly to prevent recurrence and topical steroids should be stopped.
1) Gentian violet 0.25to 2.0 5 and Castellani paint are older remedies which are effective but may sting and will stain clothing bed linen and skin
2) Systemic Agents
Outside the setting of chronic mucocutenous candiadiasis chronic systemic suppressive therapy in immune suppressed individuals is discouraged due to the risk of colonization with resistant organisms.
Fulconazole
50 to 100 mg daily for 14 days
150 mg weekly for 2- 4 weeks
Itraconazole 200 mg twice daily for 14 days .
Treatemnt of individual lesions:--a)Tinea corporis – Griseofulvin -500-1000 mg / day ( micro size ) or 375 - 500 mg /d ( ultramicrosize ) x 2-4 weeks , Fluconazole – 150mg / week 2-4 weeks , terbinafine – 250 mg daily x 1-2 weeks , Itraconazole – 200mg / day x 1 week or 100 mg / day x2 weeks , Ketoconazole – 200-400 mg /day for 2 weeks
b) Tinea corporis (children ) Griseofulvin 15-20 mg /kg / day ( micro size suspension )x2-4 weeks , Fluconazole -6 mg / kg/week 2-4 weeks , Terbinafine – 125 mg daily x 1weeks , Itraconazole – 3-5 mg / kg / day ( maximum 200 mg ) x 1 week ,Ketoconazole – not recommended
c)Tinea Pedis/manuum – Griseofulvin – 750-1000 mg / day ( micro size ) or 500- 750 mg / d ( ultramicrosize ) x 6-12 weeks , Fluconazole – 150-200 mg / week x 4-6 weeks , Terbinafine – 250 mg daily x 2 weeks , Itraconazole - 200-400 mg / day x 1 week , Ketoconazole – not recommended
d) Tinea Pedis / manuum ( children ) Griseofulvin - 15-20 mg / kg / day ( microsize suspension ) x 4 weeks , Fluconazole 6 mg / kg / week x 4-6 weeks , Terbinafine -125 mg ( < 20-40 kg ) or 250 mg ( > 40 kg ) x 2 week , Itraconazole - 3-5 mg / kg /day ( maximum 200 mg ) x 1 week , Katoconazole – not recommended
e) Tinea Vesicular - Griseofulvin – Not recommended , Fluconazole – 400 mg single dose repeat in 2 weeks in needed , Teribinafine – oral therapy not effective ,Itraconazole - 200 mg / day x 1 week Prophylaxis 200 mg BD 1 day / month for 6 months in recurrent disease , Ketoconazole – 400 mg single dose 400 mg single 200 mg OD for 5 days , 400 mg once a month for recurrent disease
f) Vaginal candidiasis –Grisofulvin- Not effective , Fluconazole - 200-400 mg daily for 5 days , Tribinfine – Not effective , Itraconazole – 200 mg 3-5 days , Katoconazole - 150 mg single dose
In the skin the most common site is in the skin folds also called Candida intertrigo .
This is seen under pendulous breasts between overhanging abdominal folds in the groin and rectal area and in the axillae.
Type A:- Why more common at Skin folds ?? contains heat and moisture providing the environment suited for yeast infection. Hot humid weather tight or abrasive underclothing poor hygiene and inflammatory diseases occurring in the skin folds such as psoriasis make a yeast infection more likely in the axillae.
Skin folds contains heat and moisture providing the environment suited for yeast infection. Hot humid weather tight or abrasive underclothing poor hygiene and inflammatory diseases occurring in the skin folds such as psoriasis make a yeast infection more likely
Type A:--INTERTRIGO
Obese people are at greatest risk. Itching burning and stinging are the most common symptoms apposing skin folds retain moisture and become warm macerated and inflamed,, Candida is the most common secondary infection but bacteria fungi or viruses may be a factor . Erosions are possible Sweat feces urine and vaginal discharge may aggravate intertrigo . The course can be recurrent and chronic.
CLINICAL FEATURES
There are two presentations In the first type pustules form but become macerated under apposing skin surfaces and develop into red papules with a fringe of moist scale at the border. Intact pustules may be found outside the opposing skin surfaces.
CUTANEOUS CANDIDIASIS(contd):
2) Type B:-The second type consists of a red moist glistening plaque that extends to or just beyond the limits of the opposing skin folds. The advancing border is long and sharply defined and has an ocean wave shaped fringe of macerated scale. The characteristic pustule of candiadiasis is not observed in intertriginous areas because it is macerated as soon as it forms .Pinpoint pustules do appear outside the advancing border and are an important diagnostic feature. There is a tendency for painful fissuring in the skin creases.
TREATMENT
A) General Measures
Education about the role of moisture and maceration is important . The following techniques may be recommended drying affected areas after bathing using a hand held hair dryer on low heat at least once a day . Supportive clothing and weight reduction air conditioning in warm environments and regular application of a plain or medicated powder to the areas.
For very inflammatory lesions open compresses three to four times a day with water or normal saline will expedite relief of symptoms. Cool water compresses applied for ½ hour two or three times a day for just a few days are rapidly effective in controlling moisture and suppressing inflammation.
B) Topical Agents
A 1 or 2 week course of group VI to VII topical steroids may be all that is necessary . long term continuous use of topical steroids in skin fold areas may result in atrophy and striae 0.1% tacrolimus may be used as an anti inflammatory agent instead of topical steroids for initial treatment or for cases requiring long term intermittent treatment Ciclopirox cream or lotion twice daily for 1-2 weeks or until resolved is another option . It is a good practice to add a topical anti yeast medication, such as miconazole creams with topical steroids. To separate and expose skin effectively in order to promote dryness administer while the patient is in the supine position. After clinical resolution topical antifungal treatments may be continued twice weekly to prevent recurrence and topical steroids should be stopped.
1) Gentian violet 0.25to 2.0 5 and Castellani paint are older remedies which are effective but may sting and will stain clothing bed linen and skin
2) Systemic Agents
Outside the setting of chronic mucocutenous candiadiasis chronic systemic suppressive therapy in immune suppressed individuals is discouraged due to the risk of colonization with resistant organisms.
Fulconazole
50 to 100 mg daily for 14 days
150 mg weekly for 2- 4 weeks
Itraconazole 200 mg twice daily for 14 days .
Treatemnt of individual lesions:--a)Tinea corporis – Griseofulvin -500-1000 mg / day ( micro size ) or 375 - 500 mg /d ( ultramicrosize ) x 2-4 weeks , Fluconazole – 150mg / week 2-4 weeks , terbinafine – 250 mg daily x 1-2 weeks , Itraconazole – 200mg / day x 1 week or 100 mg / day x2 weeks , Ketoconazole – 200-400 mg /day for 2 weeks
b) Tinea corporis (children ) Griseofulvin 15-20 mg /kg / day ( micro size suspension )x2-4 weeks , Fluconazole -6 mg / kg/week 2-4 weeks , Terbinafine – 125 mg daily x 1weeks , Itraconazole – 3-5 mg / kg / day ( maximum 200 mg ) x 1 week ,Ketoconazole – not recommended
c)Tinea Pedis/manuum – Griseofulvin – 750-1000 mg / day ( micro size ) or 500- 750 mg / d ( ultramicrosize ) x 6-12 weeks , Fluconazole – 150-200 mg / week x 4-6 weeks , Terbinafine – 250 mg daily x 2 weeks , Itraconazole - 200-400 mg / day x 1 week , Ketoconazole – not recommended
d) Tinea Pedis / manuum ( children ) Griseofulvin - 15-20 mg / kg / day ( microsize suspension ) x 4 weeks , Fluconazole 6 mg / kg / week x 4-6 weeks , Terbinafine -125 mg ( < 20-40 kg ) or 250 mg ( > 40 kg ) x 2 week , Itraconazole - 3-5 mg / kg /day ( maximum 200 mg ) x 1 week , Katoconazole – not recommended
e) Tinea Vesicular - Griseofulvin – Not recommended , Fluconazole – 400 mg single dose repeat in 2 weeks in needed , Teribinafine – oral therapy not effective ,Itraconazole - 200 mg / day x 1 week Prophylaxis 200 mg BD 1 day / month for 6 months in recurrent disease , Ketoconazole – 400 mg single dose 400 mg single 200 mg OD for 5 days , 400 mg once a month for recurrent disease
f) Vaginal candidiasis –Grisofulvin- Not effective , Fluconazole - 200-400 mg daily for 5 days , Tribinfine – Not effective , Itraconazole – 200 mg 3-5 days , Katoconazole - 150 mg single dose
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