From the Guidelines
Candida intertrigo and inverse psoriasis are distinct skin conditions that require different diagnostic approaches and treatments to improve morbidity, mortality, and quality of life. To distinguish between the two, it's essential to consider their characteristic presentations. Candida intertrigo is a fungal infection caused by Candida yeast, typically presenting as bright red, moist patches with satellite pustules and erosions at the edges, often accompanied by intense itching, burning, and a characteristic yeasty odor [ 1 ]. In contrast, inverse psoriasis is an inflammatory condition characterized by smooth, well-demarcated, bright red plaques without the satellite lesions seen in candida, appearing shiny and lacking the typical scaling of plaque psoriasis due to moisture in the skin folds [ 1 ].
Key Differences
- Candida intertrigo:
- Fungal infection
- Bright red, moist patches with satellite pustules and erosions
- Intense itching, burning, and yeasty odor
- Confirmed by KOH preparation showing pseudohyphae
- Inverse Psoriasis:
- Inflammatory condition
- Smooth, well-demarcated, bright red plaques
- Shiny appearance without scaling
- May require biopsy for diagnosis
Diagnostic Approaches
For candida intertrigo, a diagnosis can be confirmed by a wet mount preparation with saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae [ 1 ]. Inverse psoriasis may require a biopsy to show typical psoriatic histology.
Treatment Options
Treatment for candida intertrigo includes topical antifungals like clotrimazole, miconazole, or nystatin applied twice daily for 2-4 weeks, with oral fluconazole 150mg weekly for 2-3 weeks in severe cases [ 1 ]. Inverse psoriasis treatment involves low-potency topical steroids like hydrocortisone 1% or non-steroidal alternatives like tacrolimus 0.1% or pimecrolimus 1% cream twice daily [ 1 ]. Both conditions benefit from keeping affected areas dry, wearing loose clothing, and using barrier powders, though these measures alone won't resolve either condition without appropriate medication.
From the Research
Distinguishing Features
- Candida intertrigo and inverse psoriasis can be difficult to distinguish due to their similar clinical presentations, particularly in intertriginous areas of the skin 2, 3.
- Inverse psoriasis is a clinical variant of psoriasis that can masquerade as candidal intertrigo, making diagnosis challenging 2, 3.
- Dermoscopy can be a useful tool for non-invasive diagnosis of inverse psoriasis 4.
Clinical Characteristics
- Inverse psoriasis typically presents with smooth, red, and shiny lesions in the folds of the skin, such as the inguinal, gluteal, and inframammary areas 3, 5.
- Candida intertrigo, on the other hand, is a fungal infection that can cause redness, itching, and discharge in the affected areas 3.
- Pruritus is a common symptom of inverse psoriasis, occurring in up to 92% of cases 3.
Diagnostic Considerations
- A diagnosis of inverse psoriasis should be considered when a patient presents with treatment-resistant candidal intertrigo 2, 3.
- A thorough medical history and physical examination, along with dermoscopy and other diagnostic tools, can help distinguish between candida intertrigo and inverse psoriasis 4, 2.
- Awareness of the possibility of inverse psoriasis is crucial for accurate diagnosis and effective treatment, particularly in patients who have been misdiagnosed with candidal intertrigo 2, 3.
Treatment Options
- Treatment of inverse psoriasis can be challenging and may involve topical corticosteroids, topical calcineurin inhibitors, vitamin D analogs, and biologic therapies 4, 6, 5.
- Systemic therapies, such as IL-17 inhibitors and PDE-4 inhibitors, may also be used in the treatment of genital and inverse psoriasis 5.
- Topical antifungals are often ineffective in treating inverse psoriasis and may delay diagnosis and appropriate treatment 3.