Candidiasis of the skin

Candidiasis is a fungal disease of the skin, mucous membranes and internal organs caused by fungi of the genus Candida.

The disease candidiasis of the skin is most common in the tropics and subtropics.

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What causes skin thrush?

Fungi of the genus Candida are opportunistic microorganisms. They are widespread in the external environment, vegetating mainly in the soil of meadows, gardens and vegetable gardens, on the bark of fruit trees, as well as in fruits, vegetables and fruits.

As saprophytes, they are found on the skin, mucous membranes and in the feces of 1/5 of healthy people. The main pathogen is Candida albicans, less often - Candida tropicalis, Candida pseudotropicalis, etc. The source of infection is a person with candidiasis (sexual contact, kissing, dishes, infection of the fetus when passing through an infected birth canal). Infection is facilitated by exogenous factors (humid climate, maceration of the epidermis, manual processing of vegetables, fruits, berries in canning and confectionery production).

Pathogenetic factors include endocrinopathies, hypovitaminosis, immunodeficiency, long-term use of cytostatics and broad-spectrum antibiotics, etc.

Histopathology of cutaneous candidiasis

In superficial skin lesions, intercellular edema of the epidermis, exocytosis with the presence of the pathogen in the thickened stratum corneum, and a nonspecific inflammatory infiltrate in the dermis are observed. In granulomatous forms, granuloma with giant cells of foreign bodies and microabscesses with neutrophilic granulocytes are observed in the dermis.

Symptoms of skin candidiasis

Clinically, a distinction is made between superficial candidiasis of the mucous membranes, skin, nails, chronic generalized granulomatous and visceral candidiasis.

Candidal stomatitis often develops in infants, but can also occur in older people weakened by chronic diseases. Candidal stomatitis develops in weakened, post-term or premature babies. The pathological process begins with hyperemia and swelling of the mucous membrane of the cheeks, palate, gums, tongue, where pinpoint white plaques appear, the size of which ranges from a point to a pinhead, resembling curdled milk ("thrush"). Over time, the number and size of the lesions increase, they merge and form films of varying sizes. When they are removed, a pink, sometimes eroded, bleeding surface is visible. In adults (severe diseases that lead to a weakened immune system), the disease usually begins after injury to the mucous membrane, for example, by dentures. After the hyperemia and swelling stage, a thick and rough plaque appears, which, when removed, reveals erosions. When the tongue is affected (glossitis), a white filmy coating is observed not only on the back of the tongue, but also on the lateral surfaces, in the folds (grooves); the tongue increases in size due to edema, and the filiform papillae are smoothed out.

With candidal tonsillitis, in addition to plaque, plugs form on the tonsils, but swallowing is painless, body temperature does not rise, and regional lymph nodes are not enlarged.

In acute and subacute candidal vulvovaginitis, hyperemia and edema of the mucous membrane, the presence of a white coating, small erosions with scalloped outlines and rejected epithelium along the periphery are observed. Whitish, crumbly, creamy or liquid discharge is observed. Subjectively, patients are bothered by itching.

Candidal balanoposthitis develops after sexual contact with a patient suffering from genital or anal candidiasis. Balanoposthitis is characterized by the following symptoms: formation of a white coating on the inner layer of the foreskin and the glans penis, combined with superficial erosions; patients are subjectively bothered by burning and pain. When the inner layer of the foreskin and the coronal groove are affected, they become deep red, edematous and moist.

The following symptoms are characteristic of candidal cheilitis: redness of the vermilion border of the lips, dryness, burning, tightening, grayish peeling scales.

Most often, large folds of skin are affected (under the mammary glands, inguinal, intergluteal). Clinically, the disease candidiasis of the skin occurs in the form of diaper rash. The boundaries of the lesion are clear, with a border of whitish macerated epidermis, a varnished, raspberry-blue surface. The resulting erosions are clearly delimited from the surrounding skin and along their periphery there are fringes of exfoliated epidermis. Erosion and maceration of the epidermis are limited to the contacting surfaces of the folds. Around the lesions, there are sometimes visible seepage in the form of small bubbles, pustules or erythematous-squamous elements.

On the hands, the third interdigital fold is most often affected, which becomes red; the horny layer around it is swollen, whitish, with a pearly hue. The process often spreads to the lateral surfaces of the main phalanges. This form of candidiasis is often found in women working in confectionery and food processing plants for fruits and vegetables. The course of the disease is chronic, with relapses; patients are bothered by itching and burning.

Similar lesions can be behind the ears, around the navel, anus. On smooth skin, candidiasis can occur in the form of erythematous, vesicular, psoriasiform rashes.

Candidal paronychia often begins with damage to the nail fold. Hyperemia and swelling (cushion-like appearance) of the periungual fold occur, and when pressed, a drop of pus is released from under it. Over time, paronychia becomes chronic, the nail plate is affected, becoming brown, bumpy, with stripes and depressions, then thinning, sometimes peeling off. Candidal paronychia and oyichia can be occupational diseases in confectioners and workers in fruit and berry canning plants.

Chronic generalized granulomatous candidiasis usually develops in individuals with immunodeficiency and endocrinopathies. The disease begins at an early age with candidiasis of the oral mucosa, glossitis, and macrocheilia. Then onychia and paronychia develop, the smooth skin of the trunk, extremities, and scalp is affected in the form of pseudofurunculosis and decalvans folliculitis. The lesions on the skin are hyperemic, infiltrated, with lamellar peeling, papules, and tubercles. They resolve with scarring and focal alopecia on the scalp. Such patients often have pneumonia, gastritis, hepatitis, epileptiform seizures, and developmental delays.

Candidiasis of internal organs (respiratory tract, digestive tract, genitourinary system, CNS candidiasis, candidiasis, etc.) develops with long-term antibiotic therapy.

Due to irrational irritant therapy, patients with candidiasis may develop allergic rashes - levurides in the form of erythematous-squamous, vesicular and other rashes, often accompanied by general symptoms (headache, malaise, etc.).

Differential diagnosis of cutaneous candidiasis

The disease candidiasis of the skin should be distinguished from tuberculosis, coccidioidomycosis, pulmonary blastomycosis, and other visceral mycoses.

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Treatment of skin candidiasis

It is necessary to simultaneously carry out symptomatic, pathogenetic and etiotropic treatment of skin candidiasis.

Of the etiotropic agents, fluconazole (flunol, difluzol, diflucan, etc.), itraconazole (teknazol, orungal, etc.), and lamisil are prescribed. For vaginal candidiasis, fluconazole is used once at a dose of 150 mg, for skin candidiasis - 50 mg daily for 2-4 weeks, for oropharyngeal candidiasis - 50 mg daily for 14 days. Intraconazole for candidal vulvovaginitis is prescribed at 200 mg in 2 doses per day, for cutaneous candidiasis - 100-200 mg per day (the duration of therapy depends on the prevalence of the process, for oral candidiasis - 100 mg once a day for 15 days. For vulvovaginal candidiasis, vaginal suppositories of zalain are effective (administered intravaginally, once).

Externally, 1-2% iodine solution, furacilin, brilliant green, etc. are used. The therapeutic effect is enhanced by prescribing antifungal drugs for local use (canesten, travogen, lamisil, microspor, etc.).

It is necessary to eliminate concomitant diseases (diabetes, immune deficiency, etc.). The effectiveness of treatment of skin candidiasis is increased by vitamins (A, C, group B) and general tonics.