candida dermatology

1. CANDIDIASIS
HABAKUK LARRY OMONDI

2. introduction
• Most commonly caused by the yeast Candida
albicans.
• Superficial infections of mucosal surface
Common in otherwise healthy individuals
• the immunocompromised can occur the
esophagus and tracheobronchial tree.

3. EPIDEMIOLOGY
• Age- young and old
• Host factors
I. Immunocompromise
II. Diabetes mellitus
III. Obesity
IV. Polyendocrinopathies
V. Chronic debilitation.

4. Classification of Candidiasis
• cutaneous
• Chronic mucocutaneous
• Genitalia
• Mucosal
• Candidemia

5. Cutaneous Candidiasis
• occurs in moist, occluded cutaneous sites
Clinical manifestation
• Intertrigo -Erythema. Pruritus, tenderness,
pain.
• Occluded Skin Under occlusive dressing,
under
cast, on back in hospitalized patient.
• Diaper Dermatitis Irritability, discomfort with
urination, defecation, changing diapers.

6. Cutaneous Candidiasis cont.
Skin lesions
intertrigo
• Initial pustules on erythematous base become
eroded and confluent.
• then sharply demarcated, polycyclic,
erythematous, eroded patches with small
pustular lesions at the periphery

9. Diaper Dermatitis
• Erythema, edema with papular and
pustular esions; erosions, oozing,
collarette-like scaling at the margins of
lesions

11. Differential diagnosis
• Intertrigo- Nonspecific intertrigo,
streptococcal intertrigo, intertriginous
psoriasis, erythrasma , dermatophytosis ,
pityriasis versicolor
• Diaper Dermatitis - Atopic dermatitis,
psoriasis , irritant dermatitis, seborrheic
dermatitis.

12. Management of Cutaneous
Candidiasis
• Prevention -Keep intertriginous areas
dry.Washing with benzoyl peroxide
• Topical antifungal agents : Nystatin,
azole,or imidazole cream
• Oral antifungal agents

13. Mucosal candidiasis
CDC Surveillance Case Definition for
AIDS
Candidiasis of the esophagus, trachea,
bronchi, or lungs is an AIDS-defining
condition if the patient has no other cause
of immunodeficiency and is without
knowledge of HIV antibody status.

14. Classification of mucosal
candidiasis
a) Superficial mucosal candidiasis
b) Oropharyngeal candidiasis:
pseudomembranous candidiasis (thrush)
erythematous (atrophic) candidiasis;
candidal leukoplakia (hyperplastic
candidiasis);
angular cheilitis
c) Deep mucosal candidiasis- esophageal,
tracheobronchial candidiasis

15. Clinical manifestation
Oropharynx
• Burning or pain on eating spices/acidic foods
• Cosmetic concern
• Odynophagia.
Esophagus
• Often asymptomatic.
• Odynophagia

16. Mucosal Lesions
Pseudomembranous Candidiasis
(Thrush)
• Removal with a dry gauze pad leaves an
erythematous mucosal surface
• White-to-creamy plaques on any mucosal
Surface eg Dorsum of tongue, buccal
mucosa, hard/soft palate, pharynx tree

18. Erythematous (Atrophic) Candidiasis
Smooth, red, atrophic patches
• Candidal Leukoplakia
White plaques that cannot be wiped off but
regress with prolonged anticandidal therapy.

19. Differential diagnosis
• Pseudomembranous Candidiasis
(Thrush) -Oral hairy leukoplakia,
geographic tongue, hairy tongue, lichen
planus, bite irritation.
• Atrophic (Erythematous) Candidiasis -
Lichen
planus

20. • Topical antifungal agents : Nystatin Oral
suspension
• Oral antifungal agents-
Fluconazole
200 mg PO once followed by 100 mg/d for
2–3 weeks, then discontinue.
Itraconazole
Ketoconazole

21. Genital candidiasis
• Occurs on the nonkeratinized genital
mucosa
• Females are more affected than men

22. Clinical manifestation
Vulvitis/ Vulvovaginitis
• Pruritus,
• vaginal discharge
• vaginal soreness
• vulvar burning
• dyspareunia
• dysuria

23. Balanoposthitis, Balanitis
• Burning
• itching,
• redness

24. Mucosal Lesions
Vulvovaginitis
Erosions, pustules, erythema,swelling,
removable curdlike material on vulva
• Vaginal erythema and edema; white
plaques
that can be wiped off

26. MANAGEMENT
• Azoles/imidazoles More effective than
nystatin
• Clotrimazole: 1% cream or vaginal tablet