Okay now when you first hear candida,
this may be the type of image you think of first.
This is classically thrush, right?
Oropharyngeal thrush we'd commonly see in folks who are
immunocompromised from using steroid inhalers or HIV, etcetera.
But we're gonna focus on another
manifestation of candida called intertrigo.
Of note, candida can also manifest on the genitals, on the tip
of the penis called balanitis or vaginal candidiasis as well.
Risk factors for candida include heat,
immunosuppression as I mentioned, excess sweating.
Diabetes is a big risk factor.
If somebody's on steroids for whatever reason, recent antibiotic
use cause that kills off a lot of the normal skin flora
and obesity, with potentially some pannus which
could contribute to the heat and hygiene issue.
But let's again, we're gonna focus on
the skin today and look at intertrigo.
So this is a classic picture of
candidal intertrigo under the breasts.
What you'll see in this condition is well-demarcated,
itchy, beefy red, erythematous patches
and sometimes you'll see large distribution of
confluence underneath the breast or any inguinal folds
and then what's called 'satellite lesions' which are smaller areas
that are separated away from the primary confluent region.
It occurs in any moist skin fold,
- maybe that's under the breast, so called submammary.
maybe it's in the groin or the gluteal cleft,
maybe it's underneath pannus like
I said in someone who's obese,
or you might find it in the axilla.
Occasionally, you'll even find pustules though
I will say that I don't see that very often.
The diagnosis, similar to many fungal
infections is gonna be with the KOH prep.
And ultimately it's very readily treatable
with a Nystatin cream or Nystatin powder.
Sometimes you'll need to use oral -azoles like fluconazole,
ketoconazole, depending upon the extent of the infection.
Alright, again while the lesion that our
patient has is somewhat itchy and erythematous,
it's in an unusual locaiton on the arm, and a host
that doesn't seem to have risk factors for intertrigo.
So I think, we can safely take candidal
intertrigo also off our list, x-ing it out.