Fungal infections of the skin are a common medical problem throughout the globe. These infections are usually superficial meaning that it does not extend deeper than the outermost layers of the skin. Most of these infections are caused by a type of fungus known as dermatophytes which have specialized enzymes to digest human skin. These fungi are also commonly referred to as a ringworm. However, yeasts can also cause skin infections. These type of fungi are usually associated with vaginal and mouth thrush but sometimes the skin may also be infected.
What is cutaneous candidiasis?
Cutaneous candidiasis is the medical term for a yeast infection of the skin caused by the Candida species of yeasts. Of this species, it is Candida albicans that is usually responsible for most human yeast infections, be it within the vagina, mouth or skin. While skin candidiasis can occur anywhere on the skin, it tends to arise at the folds of the body especially where the area is warm and moist. Therefore covered areas that tend to sweat are more prone,
The groin region (between genitalia and around the anus), feet, armpits, under the breast in women and the buttock region in babies (diaper dermatitis) are more common sites. Skin candidiasis can affect any person of any age but it often tends to be more common in newborns and the elderly. It is also more commonly associated with immunocompromised individuals and with antibiotic use.
Causes of Cutaneous Candidiasis
Candidiasis is the term for infection by Candida yeasts. Candida albicans is the most common species involved in human infections but other Candida species may also be involved at times such as Candida glabrata, Candida guilliermondii, Candida parapsilosis and Candida tropicalis. These yeasts are naturally found in the mouth and vagina but in controlled populations. It is not considered as part of the natural skin microbes (normal skin flora) but does colonize the skin surface every now and then.
The skin has defenses against Candida species of yeasts but for various reasons this can be compromised. Often these yeasts require some irritation or break in the skin in order to establish an infection. As with all fungi, it tends to thrive in warm moist areas of the body and the creases of the body are by far the more likely areas to be affected. Those areas that are irritated or injured with chaffing are particularly prone. It is important to other that other species apart from Candida may be involved in skin yeast infections.
Skin candidiasis is not contagious and it is uncommon for the infection to spread to close contacts in the same way as dermatophyte (ringworm) skin fungal infections.
- HIV infection and other diseases that weakened the immune system.
- Diabetes and other endocrine diseases including Cushing syndrome and hypoparathyroidism.
- Antibiotic use.
- Nutritional deficiencies including vitamins B1, B2, B6 and C.
Environmental and lifestyle factors include living in warm humid areas, poor hygiene, infrequent undergarment changes including infrequent diaper changes in babies, tight clothing that may cause chaffing and excessive sweating (hyperhidrosis).
Candida Diaper Rash
Candida diaper rash is common especially in newborns. These newborns often have oral thrush and the yeasts are also in the gut. The yeasts are passed out with the stool where it can then infect the skin. Irritation of the skin due to friction caused by the diapers as well as the moistness from urine and stool are precipitating factors. Detergents and disinfectants that make contact with the skin in the area further contribute to the likelihood of candidal diaper dermatitis.
Symptoms and Pictures
Cutaneous candidiasis is typically red, raised and itchy over the affected area. There are numerous tiny pimples that initially appear scaly and over time it merges to form eroded weepy lesions with scalloped edges. There may also be burning and pain particularly when the skin is eroded.
Candidiasis between the fingers
Candidiasis of the armpit
Candidiasis of the palm
Treatment of Skin Thrush
Skin candidiasis can be treated with topical and/or oral antifungal agents. However, it can resolve spontaneously without any treatment. In most cases topical applications in the form of powders or ointments are sufficient to eradicate the yeast. It may also require a topical corticosteroid to reduce inflammation and assist with healing of the skin.
Topical applications for skin candidiasis contain the following agents:
Oral agents for skin candiasis include:
Oral medication is only considered for severe cases or where topical agents do not yield the desired results. Cutaneous candidiasis often recurs. It usually does not lead to any significant complications in most people. However, in individuals with severe weakening of the immune system the infection can spread deeper beyond the skin. Secondary bacterial infections may occur and this may need to be treated first.
Prevention of Skin Candida
Preventative measures should be followed especially after the skin yeast is treated.
- Hygiene does play a role and it is important to bathe change frequently. However, antibacterial soaps should not be used daily for bathing as it can dry the skin and disrupt the surface microbes that may promote tears in the skin and increase the likelihood of yeast overgrowths.
- Frequent diaper changes are important in newborns and infants. Although newer diapers are able to absorb the moisture, it does not work as effectively for stool as it does for urine. The fecal particles can irritate the skin and lead to dermatitis which can then become infected with yeasts.
- Avoid using very tight clothing, especially undergarments that make contact with skin creases. Even minor chaffing can worsen over time and lead to breaks in the skin which then become infected with yeasts. Use loose fitting clothing, especially underwear, made of light airy textiles.
- Use drying powders in areas where there is moisture like the armpits, feet and groin regions. Antifungal drying powders may be a better option if there is a history of fungal skin infections. Minimize sweat build up by using lighter clothing especially in hot and humid climates.