General Illness Information
Common Name:	CANDIDIASIS OF THE SKIN
Medical Term:	Moniliasis
Description:	Infection of the skin by yeast organism (Candida albicans- formerly called monilia). Most commonly affects skin folds (eg. groin, under the breast) as well as the vagina, scrotum, underarm area etc. Mildly contagious from person to person. Localized spread common. Nurses, bartenders, dairy farmer and others doing "wet" work frequently have nail infection with candida.
Causes:	Yeast infection of the skin caused by candida fungus (usually Candida albicans). The spore form of this organism normally grows in the intestinal tract and the vagina. Skin signs do not begin until yeast changes from its spore form to another growth phases, the mycelial phase. Damaged skin, moisture and warmth are all necessary for the infection to take over. Inadequate immunity from disease such as AIDS or from immunosuppressant drugs.
Prevention:	Take antibiotics only when prescribed. Avoid excessive sweets. Keep skin cool and dry. Wear cotton underwear.
Signs & Symptoms
Bright red patches with poorly defined borders. They are often 6cm to 12cm in diameter or larger. Some areas are weeping or oozing- thick, white or yellow discharge. Skin appears moist and crusted. Itching is usually present. Smaller plaques (less than 1mm in size) sometimes surround larger plaques. They can form small satellite pustules (small white blisters with pus inside). Candida can also infect mucous membranes- such as the lining of the mouth and vagina.   Symptoms do vary depending on the site of infection: Infection in skin folds (Intertriginous infection) and in the navel- usually presents with a red rash and patchy areas that ooze small amounts of whitish liquid, and satellite lesions appear around the edges of the rash. This rash usually burns or is itchy. Candida rash around the anus may be raw, white or red and is usually itchy. Penile Candida infections- usually occurs in men who are either diabetic or have female sex partners with vaginal candidiasis. The infection is either asymptomatic or may present with a red, scaly, painful eruption on the underside of the penis Perleche- is a candida infection at the corners of the mouth. It presents with cracks and tiny cuts. It is usually found in people with ill-fitting dentures, in whom the corners of the mouth are constantly wet allowing yeast to grow there Candidal paronychia- it is infection of the nail bed and presents with painful swelling and pus around and under the nail. Nails infected with Candida turn white or yellow and separate from the finger or toe. Vaginal candidiasis (Vulvovaginits) occurs more often in women who are diabetic or pregnant or on antibiotics. This infection presents with thick, white or yellow discharge from the vagina and itching, burning and redness along the walls and external area of the vagina. Thrush- it is a Candida infection inside the mouth. It presents with creamy white patches, on the tongue and on the sides of the mouth, which can be scraped of easily with a spoon or a tongue depressor. Thrush is quite common in otherwise healthy children but not in adults. Candidiasis in adults may signal impaired immunity such as caused by diabetes or AIDS. However, antibiotic's that kill off competing bacteria increases chances of developing thrush.
Risk Factors
Use of oral antibiotics, which will kill off bacteria, and allow fungi to multiply. Use of steroids (oral, injectable or topical). Diabetes. Obesity. Poor nutrition. Excessive sweating. Crowded or unsanitary living conditions. Use of birth control pills. Frequent douching. Dentures.
Diagnosis & Treatment
General Measures: Diagnostic tests may include laboratory study of a skin scraping or discharge. Treatment involves therapy for the disorder and the underlying condition that predisposes you to candidiasis. Keep skin cool and dry. Expose affected areas to sunlight as much as possible. Wear loose cotton clothing. Avoid synthetic or wool fabrics. Protect skin from injury. Hairdryer may help in hard to reach areas e.g. nails, toe webs, and groin folds.
Medications: Antifungal topical medications are usually prescribed, e.g. nystatin cream is often recommended for skin, vaginal and penile infections. The cream is applied twice daily for 7 to 10 days. Suppositories are also available for treatment of vaginal and anal infections. Thrush can be treated with liquid medications or lozenges. Antifungal medication is sometimes combined with corticosteroids ointment to help relieve itching and pain, though it does not cure the infection. Gently massage a small amount into the affected area as directed. Use only enough to cover. Larger amounts don't help. Burow's solution may help relieve symptoms, for oozing lesions. Oral antifungals are now available, and are very effective and especially useful in resistant cases.
Activity: No restrictions, except to avoid heat and sweating.
Diet: No special diet. Eating yogurt, buttermilk or sour cream, or taking acidophilus tablets may help prevent yeast infections that may result as an adverse effect of the drugs.
Possible Complications : Generalized spread. Secondary bacterial infections (rare). Allergic response to a skin disorder (rare). Blood poisoning (rare).
Prognosis
Usually curable in 2 weeks with treatment. Without treatment, healing may be slow (up to 4 to 5 years). Recurrence is common.