InfectionYeastICD-10 B37.x
Cutaneous candidiasis
Cutaneous moniliasis · candidal intertrigo
Cutaneous candidiasis is an opportunistic mycosis caused by Candida species, most commonly C. albicans. Disease occurs in moist intertriginous areas, occluded body folds, mucosae and around medical / surgical wounds. It is a daily DDx for eczema, psoriasis, EMPD, post-irradiation dermatitis, intertrigo and bullous pemphigoid. Risk factors include diabetes, obesity, immunosuppression (HIV, ICI, chemotherapy, transplant, biologics), broad-spectrum antibiotics, denture wear, occluded skin and pregnancy.
CurrentLast reviewed 16 May 2026
Microbiology
- Candida albicans commonest; also C. glabrata, C. krusei, C. tropicalis, C. parapsilosis, C. auris (emerging multidrug-resistant).
- Yeasts to pseudohyphae transition under permissive conditions (warm, moist, occluded).
- Risk factors:
- Diabetes, obesity, hyperhidrosis.
- Immunosuppression — HIV, chemotherapy, transplant, biologics, ICI.
- Broad-spectrum antibiotics; oral or inhaled corticosteroids.
- Pregnancy, hormonal therapy.
- Occlusion — dressings, ostomies, intimate clothing.
- Denture wear (angular cheilitis, oral pseudomembranous).
Clinical patterns
- Candidal intertrigo: well-demarcated beefy-red glistening plaque in flexures (axillae, groin, inframammary, abdominal folds), with characteristic satellite pustules / papules.
- Diaper candidiasis in infants with satellite lesions and involvement of inguinal folds (cf. irritant dermatitis which spares folds).
- Chronic paronychia: bolstered nail-fold; pus emerges on pressure.
- Oropharyngeal (thrush): white pseudomembranous, atrophic / erythematous, hyperplastic; angular cheilitis (perlèche).
- Vulvovaginal candidiasis: pruritus, curd-like discharge.
- Balanitis: erythema, pustules, satellite lesions on glans / prepuce.
- Chronic mucocutaneous candidiasis: persistent infection in immunodeficiency syndromes (autosomal dominant, AIRE mutations, IL-17 pathway defects).
- Disseminated candidiasis: erythematous papules / pustules in neutropenic / ICU patients; emergency.
Investigations
- Skin scraping / swab for direct microscopy (KOH) and culture.
- Atypical / persistent: biopsy (PAS / Grocott stain).
- Blood cultures and ophthalmology review if disseminated suspected.
- Screen for predisposing factors: HbA1c, HIV, immunoglobulins, CD4/CD8 if recurrent / chronic.
Differentials
- Tinea cruris — well-demarcated; advancing scaling edge; central clearing; satellite pustules absent.
- Inverse psoriasis — sharply demarcated; less moist; lacks pustules.
- Seborrhoeic dermatitis — greasy scale.
- Contact / irritant dermatitis — pruritus dominates.
- Hailey-Hailey disease — flexural maceration; family history; biopsy.
- Extramammary Paget disease — vulval / perianal; biopsy if unresolved.
- Bullous pemphigoid (intertriginous variant), erythrasma (coral-red Wood lamp).
Management
- Keep area dry; loose breathable clothing; barrier creams (zinc / dimeticone).
- Topical first-line: clotrimazole / miconazole / ketoconazole / nystatin BD-TDS for 1-2 weeks.
- Combination steroid-azole (e.g. clotrimazole / hydrocortisone) for symptomatic intertrigo <7 days.
- Oral (extensive, recurrent, immunosuppressed):
- Fluconazole 50-100 mg OD for 7-14 days (or 150 mg single dose for vulvovaginal).
- Itraconazole 100-200 mg OD for resistant disease.
- Treat predisposing factors: glycaemic control, weight management, denture hygiene, smoking cessation, review immunosuppression.
- Chronic mucocutaneous candidiasis: long-term azole prophylaxis; immunology referral.
- Disseminated candidiasis: IV echinocandin, ID team involvement.
References
- Pappas PG et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1-e50.
- Goh BK, Lim Y. Recurrent vulvovaginal candidiasis: a review of guideline recommendations. Aust N Z J Obstet Gynaecol. 2020;60:485-491.
- Pittet D et al. Candida auris infection: a clinical and public-health threat. Clin Infect Dis. 2022;75:e1-e10.
- British Association of Dermatologists. Candidiasis — patient information leaflet. London: BAD; 2022.
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