Candidiasis_0815 Derm Dx
An obese man, aged 56 years, presents with a groin rash that has been present for several weeks. He states that it is very itchy and uncomfortable and that it seems to have worsened following use of hydrocortisone. The patient’s medical history is significant for type 2 diabetes controlled with metformin.
Examination reveals a red eruption of the intertriginous folds. The area is moist, malodorous, and raw. Scattered papules are noted at the periphery of the rash. The penis and scrotum are not involved.
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Candidal intertrigo is a superficial infection most commonly caused by Candida albicans. Candidal intertrigo occurs in large skin folds, such as the breast, groin, and axillary areas. The warm, moist environment of these sites is conducive to yeast overgrowth. Factors that predispose individuals to the infection include obesity, pregnancy, diabetes, and broad spectrum antibiotics.1,2
The condition is usually diagnosed clinically. Candidal intertrigo presents as well-demarcated, erythematous patches with satellite papules or pustules. Microscopic examination of skin scrapings and culture will be positive.
Candidal intertrigo can resemble other conditions such as inverse psoriasis. Inverse psoriasis characteristically presents as erythematous patches and plaques that are sharply demarcated in the intertriginous areas with minimal scaling. Satellite lesions, which are characteristic of candidiasis, are absent.3
In addition to maintaining dry intertriginous skin folds, treatment of candidal intertrigo is best accomplished with topical antifungals.1 Extensive involvement may warrant oral anti-yeast medications such as fluconazole or itraconazole. Treatment failure suggests noncompliance or an alternative diagnosis.3
Megha D. Patel is a student at the Commonwealth Medical College, Scranton, Pennsylvania.
Stephen Schleicher, MD, is an associate professor of medicine at the Commonwealth Medical College and an adjunct assistant professor of dermatology at the University of Pennsylvania Medical College. He practices dermatology in Hazleton, Pennsylvania.
- Habif TP. Candidiasis. Clinical Dermatology. 5th ed. Maryland Heights, Missouri: Mosby Elsevier; 2010:523, 532.
- Quiroz-Mejía R, Sifuentes-Osornio J, Orozco-Topete R. Candidal intertrigo in hospitalized patients: Etiology, risk factors, and its association with systemic candidiasis. J Am Acad Dermatol. 2011;64(2 Suppl 1):AB102.
- Wilmer EN, Hatch RL. Resistant “Candidal intertrigo”: Could inverse psoriasis be the true culprit? J Am Board Fam Med. 2013;26(2):211-214.