Yeast infection
Pityriasis versicolor
Caused by malassaezia furfur and M. globosa, which are part of the normal
follicular flora
Present with multiple hyperpigmentd or hypopigmented patches with fine scales.
Demonstration of this associated scale may require scratching or stretching the
skin surface
Decreased pigmentation may be secondary to the inhibitory effects of dicarboxylic
acids on melanocytes (these acids result from metabolism of surface lipids by the
yeast).
More common during the summer months
Usually asymptomatic. May be pruritic
Malassaezia is lipophilic, therefore,(1) seborrheic regions, in particular the upper
trunk and shoulders, are the favored sites of involvement and (2) there is increased
incidence in adolescents.
Malassaezia is dimorphic i.e. grow both as a yeast and hyphae
Dx: Microscopical KOH examination of scale scraping shows “Spaghetti and
meatballs”
which are hyphae and spores, respectively.
Rx:Topical treatment : selenium sulfide or ketaocoazole shampoo applied daily for
a week. Others: Other imidazoles and sulfur
Systemic : itraconazole (200 mg/day) for a week, fluconazole (300 mg) weekly for
two weeks .
Candidiasis(Candidosis or Moniliasis)
C. albicans is a common inhabitant of the gastrointestinal, genitourinary tracts,
and skin
Under the right conditions e.g. decreased immunity, moisture and decreased
competing flora , candida albicans can cause lesions of the skin, nails, and mucous
membranes
Predisposing factors:
Diabetes mellitus
Xerostomia (saliva inhibit growth of candida)
Occlusion e.g. under adhesive plaster
Hyperhidrosis
Use of corticosteroids and broad- spectrum antibiotics
Immunosuppression, including HIV infection
Diagnosis
(1) Microscopical KOH examination show budding yeast and pseudohyphae in
stratum corneum and superficial mucosa
(2) Biopsy
(3) Sabouraud culture
Oral candidiasis (Thrush)
The mucous membrane of the mouth may be involved in healthy infant
In the newborn, the infection may be acquired from contact with the vaginal tract
of the mother.
White-to-creamy plaques on any mucosal surface. Removal with a dry gauze pad
leaves an erythematous mucosal surface. Can involve dorsum of tongue, buccal
mucosa, hard/soft palate, pharynx, esophagus.
Rx:
Topical: oral nystatin suspension or clotrimazole troches that dissolve in the mouth
Systemic: fluconazole and itraconazole
Angular Cheilitis (Perleche)
White plaques with slight erythema of the mucous membrane at the angles of
mouth. Maceration and fissures may ensue
Is commonly related to C. albicans, but may be caused by coagulase positive S.
aureus and Gram negative bacteria. Similar changes may nutritional deficiency e.g.
riboflavin and iron.
Drooling in persons with malocclusion caused by ill fitting denture or overlap of
angles of mouth in edentulous elderly are predisposing factors for candidal
overgrowth.
RX: Topical or systemic anticandidal
Candidal vulvovaginitis
Overgrowth can cause the labia to be erythematous and macerated . There might
be pruritus, burning and curd-like discharge
Pregnancy, high dose estrogen are predisposing factor
Candidal balanitis may be present in the sexual partner
About 20% of asymptomatic women are vaginal carriers. During pregnancy, this
rises to 40%
Candidiasis can be sexually transmitted and this is probably most important in
recurrent infections (more than 3 episodes per year).
Rx: Topical: vaginal suppositories containing nystatin or imidazole. Single-dose oral
treatment is an alternative
Balanitis
Balanitis is more common in the uncircumcised man
The skin is erythematous with pustules and erosions
Rx: topical anticandidal agents or single dose oral fluconazole. Treatment of sexual
partner is essential
Candidal intertrigo
Can involve groins or armpits; intergluteal cleft; under large breasts; under
overhanging abdominal folds; or in the umbilicus.
Red moist patches surrounded by a rim of scale (“collarette” scale) and there are
tiny pustules and papules which are observed closely adjacent to the patches,
termed “satellite or daughter” lesions
Rx: Topical anticandidal preparations are usually effective. Oral anti-candidal
agents are alternative
Diaper candidiasis
Differentiated from contact dermatitis by (1)the involvement of the folds and (2)
occurrence of many small erythematous “satellite” or “daughter” lesions scattered
along the edges of the larger patch(es)
Rx: Topical anticandidal agents are effective.
Candidal paronychia
Redness, edema, and tenderness of the proximal and lateral nail folds
Usually the fingernails are affected more than toenails
Patients commonly have an atopic background
Frequently seen in diabetics and those who work in a wet jobs
Two types:
Acute: usually caused by staph. aureus
Chronic: multifactorial i.e. Irritant dermatitis and candidiasis
Rx: Avoidance of chronic exposure to water and irritants e.g. detergents and
bringing the diabetes under control in addition to topical steroids and topical anti-
candidal agents
Erosio interdigitalis blastomycetica
Oval shaped area of macerated white skin associated with fissure and red skin at
the center on the web between fingers
Nearly always between the middle and ring fingers
Moisture beneath the ring predispose to infection
On the feet it is the fourth web space that is most often involved. Clinically, this
may be indistinguishable from tinea pedis
Rx: drying of web spaces and topical anticandidal agents