Characteristics of a Yeast Rash
A yeast rash (cutaneous candidiasis) typically presents as bright erythema with fragile papulopustules and characteristic satellite lesions, occurring most commonly in warm, moist, occluded skin areas. 1
Clinical Presentation
Primary Features
- Appearance: Bright erythema (redness) with peripheral scaling 2
- Lesion types: Papules, pustules, or nodules that may be fragile 2
- Satellite lesions: Small pustules or papules extending beyond the border of the main rash area - a hallmark diagnostic feature 3
- Distribution: Commonly affects intertriginous areas (skin folds) where moisture and friction occur 3
- Symptoms: Often associated with pruritus (itching) and burning sensation 1
Common Locations
- Skin folds (axillae, groin, inframammary regions)
- Interdigital spaces
- Perianal region
- Under occlusive dressings
- Around stomas or medical devices
- Nail folds (paronychia)
- Corners of mouth (perleche)
Diagnostic Features
Visual Identification
- Erythematous base with well-defined borders
- Peripheral scaling
- Satellite pustules or papules beyond the main border
- Maceration (softening of skin due to moisture)
- In severe cases: erosions, fissures, and crusting
Microscopic Confirmation
- Potassium hydroxide (KOH) preparation reveals:
- Pseudohyphae (linear chains of budding yeast)
- Budding yeast forms
- Note: Candida may not grow extensively through stratum corneum, so Gram stain may be needed 2
Risk Factors
Local Factors
- Occlusion and poor ventilation
- Moisture and maceration
- Altered skin barrier function
- Friction between skin surfaces
- Bodily secretions (sweat, urine, feces) 3
Systemic Factors
- Diabetes mellitus
- Immunosuppression (HIV/AIDS, medications)
- Antibiotic use
- Obesity
- Advanced age
- Corticosteroid use (local or systemic) 1
Variants of Cutaneous Candidiasis
Intertrigo
- Affects opposing skin surfaces
- Erythematous, macerated patches
- Well-defined borders with satellite lesions
- Common in obese individuals and in hot, humid weather 3
Diaper Dermatitis
- Bright red, sharply demarcated rash
- Involves skin folds with satellite papules and pustules
- Spares the inguinal folds (unlike irritant diaper dermatitis)
Perleche (Angular Cheilitis)
- Erythema, fissuring, and scaling at corners of mouth
- Often associated with denture use in elderly 4
Paronychia
- Inflammation of nail folds
- Erythema, swelling, and pain around nail
- May have purulent discharge
Differentiating Features from Other Rashes
- Bacterial intertrigo: Usually lacks satellite lesions, may have different odor
- Dermatophyte infections: Typically more scaly with active border and central clearing
- Seborrheic dermatitis: Greasy scales, different distribution (scalp, face, central chest)
- Psoriasis: Thicker plaques with silvery scale, lacks satellite lesions
- Contact dermatitis: Often has irregular borders, vesicles, and extends beyond occluded areas
Complications
- Secondary bacterial infections
- Systemic spread in immunocompromised patients (rare)
- Chronic recurrent infections
- Skin breakdown and fissuring 3
Early recognition and appropriate treatment of yeast rashes are essential to prevent complications, especially in patients with limited mobility or immunocompromise, as some cases may be misdiagnosed as pressure injuries or other skin conditions 5.