Candidiasis of skin is a superficial skin lesion caused by fungi of the genus Candida. Disease is red and edematous lesions with vesicles, papules and erosions. Most often, the process is localized in the skin folds of the axillary and inguinal areas, in the interdigital spaces and under the mammary glands. The diagnosis is confirmed by the detection of Candida fungi by microscopy of skin scraping. Treatment is carried out locally, and if necessary, general, the use of antifungal drugs.
Recently, there has been an increase in the incidence of fungal infections in general and candidiasis of skin in particular. The disease occurs in people of absolutely any age from newborns to the elderly. Since Candida fungi are conditionally pathogenic flora and are present in the body of a healthy person, their transition to a pathogenic state with the development can signal deviations occurring in the body and, first of all, a decrease in immunity.
In most people, Candida fungi enter the body in the first year of life. Further, fungi are present in the human body as a natural flora. Candidiasis of skin develops in the case of the transition of fungi from a saprophytic state to a pathogenic one. This may be due to endogenous causes, that is, changes in the human body itself. For example, metabolic disorders (dysproteinemia, obesity, diabetes mellitus), imbalance of intestinal microflora in dysbiosis, decreased immunity, weakening of the body’s defenses against chronic infections, increased sweating, vitamin deficiency can lead to the development of this disease. Some types of drug therapy can lead to changes that contribute to the appearance of candidiasis of skin: treatment with cytostatics or corticosteroids, antibiotic therapy.
It is possible to develop candidiasis of skin as a result of the action of exogenous causes, that is, environmental factors that contribute to the strengthening of pathogenic properties in Candida fungi. One of these factors is humidity. The fact is that Candida develop well in a humid environment and at the same time can turn into a pathogenic state. So disease is often affected by workers of swimming pools and baths, cleaners and housewives who are often in contact with water. Increased ambient temperature, which promotes sweating and maceration of the skin, can also be the cause of candidiasis of skin. A favorable environment for the development of pathogenic Candida fungi exists in confectionery and canning industries, where, in addition to a large number of fungi in the external environment and raw materials, there is a constant maceration of the skin of workers’ hands with sugary substances, citric, malic and other acids.
There are the following types of candidiasis of skin:
- candidiasis intertrigo — candidiasis of large skin folds;
- of the genitals;
- of the interdigital spaces of the feet and hands;
- candidiasis folliculitis is a fungal lesion of the hair follicles of the armpit, and in men in the beard and mustache area, it occasionally occurs on the scalp;
- dressing candidiasis of skin — with increased skin moisture under a plaster cast or on the back of bedridden patients;
- diaper candidiasis — in infants in the perineum.
Candidiasis of skin begins with the appearance of areas of redness on it with some swelling and various elements of the rash: papules, pustules, bubbles. After opening the elements, wet erosions are formed, which merge to form clearly delimited areas of the lesion with scalloped edges. The surface of the erosions is shiny and smooth, has a characteristic whitish coating. On the periphery of the foci of candidiasis of skin there are separate seropapules, edematous-erythematous spots, vesicles and pustules. Most often, candidiasis of skin begins with large folds of the skin: between the buttocks, in the armpits, under the mammary glands, in the groin.
Depending on the clinical picture, erythematous and vesicular forms of disease are distinguished. In the erythematous form, edematous-erythematous foci with areas of erosion predominate. The vesicular form is characterized by the presence of a large number of bubbles, pustules and papules on the background of inflamed skin.
Candidiasis of skin can take a chronic recurrent course. In this case, the manifestations described above occur during an exacerbation several times a year and are more common. Chronic candidiasis is less treatable. In severe cases, against the background of concomitant diseases and severe immune disorders, chronic candidiasis can turn into a generalized form with osteoporosis, anemia, recurrent bronchitis and pneumonia, disorders of the gastrointestinal tract and other internal organs.
Interdigital candidiasis of skin is more often observed in preschoolers and adults working in gardens and vegetable gardens. It is manifested by foci of maceration with edematous and red skin, along the periphery of which there are vesicles and papules. The localization of candidiasis of skin between the III and IV or IV and V fingers is characteristic for workers of vegetable stores and confectionery factories. Candidiasis of skin of the genitals is often combined with candidiasis vaginitis, balanoposthitis and balanitis.
The fastest and easiest way to diagnose the fungal etiology of skin lesions is to identify characteristic oval cells with elements of pseudomycelia by direct microscopy of scraping on pathogenic fungi taken from the affected area of the skin. Preliminary data can be obtained by PCR diagnostics, setting up an immunofluorescence reaction (RIF) and conducting an immune-enzyme analysis (ELISA). The quantitative determination of Candida is of diagnostic importance, since the presence of a small number of Candida fungi is normal for the microflora of the human body. The exact identification of the causative agent of candidiasis of skin and the determination of its sensitivity to antifungal drugs is carried out by sowing the scraping material on the Saburo medium.
Additionally, to identify concomitant diseases and infections with candidiasis of skin, the following can be prescribed: clinical blood test, determination of blood sugar and urine, immunogram, HIV infection, etc. If necessary, differential diagnosis of candidiasis of skin with eczema, seborrheic dermatitis, psoriasis of the skin folds, favus, recurrent genital herpes, erythematous lupus and others .
The basis of the course treatment of candidiasis of skin is the appointment of antifungal drugs. These include: antifungal antibiotics (nystatin, amphotericin B, natamycin, levorin), azole group medications (ketoconazole, isoconazole, clotrimazole, miconazole, econazole, fluconazole) and other drugs (flucytosine, dequalinium chloride, cyclopyrox, terbinafine, naphthyphine, undecylenic acid preparations). In mild cases of candidiasis of skin, in the presence of a small number of lesions, treatment is carried out only topically, using antifungal ointments for skin treatment. Laser treatment is used. With common lesions, local treatment is combined with taking antifungal drugs inside. The doses and duration of treatment depend on the severity of the process and the effectiveness of the therapy. Inadequately small doses of drugs or too short a course of treatment can lead to relapses of candidiasis of skin.
Along with antifungal therapy, concomitant diseases are treated and the body’s defenses are strengthened. Patients with candidiasis of skin should follow a low-carbohydrate diet. During treatment and in the future, to prevent relapses, it is necessary to ensure that the skin in the area of folds always remains clean and dry.