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Candida - Skin - Coggle Diagram
Candida - Skin
Risk factors
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Recent or concurrent use of drugs which promote candidal growth eg broad-spectrum antibiotics or inhaled/oral corticosteroids
Endocrine disorders - diabetes mellitus, Cushing's syndrome
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Diagnosis
Scales may accumulate, producing a white-yellow, curd-like substance over the infected area
Flexural areas (intertrigo) typically red and moist. Fringed, irregular edge and pustular/papular satellite lesions.
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Web spaces of toes/fingers - marked maceration with a thick, crusty layer.
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Balanitis, female genital, oral, fungal nail infection, nappy rash and paroychia all have their own clinical features.
Management
Offer appropriate advice to aid healing and prevent recurrence - advise the person to skin occlusion, when possible, advise the person to wash advise the person the wash skin regularly with a soap substitute and ensure skin is dried adequately. If obesity is a contributing factor offer weight loss advice.
If topical treatment is not effective or infection is widespread - oral fluconazole 50mg a day for 2 weeks, then review response to treatment. If infection stopped - stop treatment. Infection not completely resolved - consider extending the course for a further 2 weeks, swabbing to identify the causative organism, seeking specialist advice or referring to a dermatologist.
Refer to dermatologist if there is widespread or recurrent infection for which an underlying cause has not been identified or the diagnosis is uncertain.
If inflammation or itch is particularly problematic - consider mildly potent corticosteroid cream in addition to the topical antifungal. Advise to use once or twice a day for 7 days and review after 7 days. If resolved - stop. If significant improvement - continue for further 7 days. No response - discontinue corticosteroid treatment and reassess the diagnosis.
If infection is not widespread and the person is not significantly immunocompromised - prescribe a topical antifungal treatment. Adult - topical imidazole or terbinafine. Child - clotrimazole, econazole or miconazole.
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Investigations
Swabs are not routinely recommended - but may be required to if secondary bacterial infection is suspected, the person is immunocompromised or the diagnosis is uncertain.
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Definition: Candida is a yeast-like fungus, part of the commensal flora of the human GI tract and the vagina (it is not part of the normal skin flora). Colonization with Candida is usually asymptomatic.
Candidiasis is common and includes - intertrigo (skin folds), oral candidiasis (oral mucosa), genital infections, chronic mucocutaneous candidiasis.