Recurrent candidal intertrigo: challenges and solutions

Abstract

Intertrigo is a common inflammatory dermatosis of opposing skin surfaces that can be caused by a variety of infectious agents, most notably candida, under the effect of mechanical and environmental factors. Symptoms such as pain and itching significantly decrease quality of life, leading to high morbidity. A multitude of predisposing factors, particularly obesity, diabetes mellitus, and immunosuppressive conditions facilitate both the occurrence and recurrence of the disease. The diagnosis of candidal intertrigo is usually based on clinical appearance. However, a range of laboratory studies from simple tests to advanced methods can be carried out to confirm the diagnosis. Such tests are especially useful in treatment-resistant or recurrent cases for establishing a differential diagnosis. The first and key step of management is identification and correction of predisposing factors. Patients should be encouraged to lose weight, followed up properly after endocrinologic treatment and intestinal colonization or periorificial infections should be medically managed, especially in recurrent and resistant cases. Medical treatment of candidal intertrigo usually requires topical administration of nystatin and azole group antifungals. In this context, it is also possible to use magistral remedies safely and effectively. In case of predisposing immunosuppressive conditions or generalized infections, novel systemic agents with higher potency may be required.

Candida albicans interdigital foot infection: A case report highlighting the importance of antifungal susceptibility testing

“…Its change of status from commensal to pathogenic depends on the slight change of environmental conditions leading to expression of virulence factors like adhesins and invasins on its cell surface, production of hydrolases that mediate adhesion to susceptible host and biofilms formation as reported by Mayer et al (2013). C. albicans is also associated with interdigital space infection and found to be conformed to the findings of Metin et al (2018) which indicated that C. albicans, has a strong predilection for the intertriginous areas of the inguinal folds, intergluteal cleft, axillae, inframammary folds, umbilicus and the web spaces, particularly between the third, fourth, and fifth digits of the hands or feet.…”

“…The frequent isolation of C. albicans justifies its pathogenicity and is supported by the presence of underlying predisposing factors such as cancer, diabetes, prolonged use of antibiotics, hormonal therapy, oral contraception and pregnancy as reported by Metin et al (2018). The global burden of superficial fungal infection (skin, hair and nail) was put to approximately one billion and is mostly associated with candida clade with C. albicans on the lead in causing mucosal disease, Trichophyton in skin diseases and Aspergillus fumigatus in allergic fungal disease (Bongomin et al, 2017).…”

New Insights Into the Skin Microbial Communities and Skin Aging

“…This interesting finding is potentially attributable to the alteration with the aging of the dominant species Streptococcus, from probiotic communities to the conditional pathogenic genera. Because the skin barriers of the children and elder groups exist in an immature and recessive status, respectively, we detected a higher abundance of some conditional pathogenic genera, such as Neisseria, Streptococcus (elder group), and Candida (Petry et al, 2012;Beatrous et al, 2017;Metin et al, 2018). According to the clinical parameters, these species could be regarded as accelerators (negative correlations) of aging.…”

Discovery of a novel and selective fungicide that targets fungal cell wall to treat dermatomycoses: 1,3‐bis(3,4‐dichlorophenoxy)propan‐2‐aminium chloride

“…Positioned as the 4th most prevalent dermatological pathology in the last years and affecting 20‐25% of the world's population, they cause high morbidity rates . Their main aetiological agents are dermatophytic filamentous fungi and yeast such as Candida spp …”

“…[4][5][6] Their main aetiological agents are dermatophytic filamentous fungi and yeast such as Candida spp. 7,8 Dermatophytes are keratinophilic fungi, comprising species of three anamorphic genera-Microsporum, Trichophyton and Epidermophyton. 7,9 Trichophyton rubrum, Trichophyton mentagrophytes and more recently Microsporum canis have been identified as a biofilm-forming species, which worsens the therapeutic response.…”