What is the best treatment for an obese woman with a cutaneous candidiasis (yeast infection) in skin folds?

Best Treatment for Cutaneous Candidiasis in Skin Folds of Obese Women

For an obese woman with cutaneous candidiasis in skin folds, the most effective treatment is a combination of topical antifungal agents (such as clotrimazole, miconazole, or nystatin) along with keeping the infected area dry. 1, 2

First-Line Treatment

• Topical azole antifungals (clotrimazole, miconazole) or polyenes (nystatin) are highly effective for treating candidal intertrigo in skin folds 1
• Apply the topical antifungal cream to affected areas 1-2 times daily for 7-14 days 2
• For mild to moderate infections, over-the-counter preparations are usually sufficient 1, 3
• Keeping the infected area dry is critically important for successful treatment 1, 2

Specific Antifungal Options

• Clotrimazole cream (1%) applied twice daily for 7-14 days 1, 3
• Miconazole cream (2%) applied twice daily for 7-14 days 1, 2
• Nystatin cream or powder applied 2-3 times daily for 7-14 days 1, 2

Adjunctive Measures

• Use absorbent powders such as cornstarch (avoid talc-based products) to keep the area dry 2
• For areas with significant inflammation, consider short-term use of combination products containing both antifungal and mild corticosteroid (e.g., clotrimazole/betamethasone) 2
• Clean the affected areas with gentle pH-neutral cleansers and thoroughly dry afterward 2
• Consider barrier protection such as zinc oxide to provide a protective layer against moisture after the area is completely dry 2

For Resistant Cases

• If topical treatment fails, consider oral fluconazole 150-200 mg daily for 7-14 days 1
• For non-albicans Candida species that don't respond to azoles, consider alternative topical treatments such as boric acid 1, 2
• Ciclopirox is an excellent broad-spectrum antifungal agent that can be effective for resistant cases 4

Prevention of Recurrence

• Maintain good hygiene and keep skin folds dry 2
• Consider using absorbent cotton undergarments 2
• For patients with recurrent infections, intermittent prophylactic use of topical antifungals may be beneficial 1
• Weight loss should be encouraged as a long-term strategy to reduce skin fold depth and moisture accumulation 2

Common Pitfalls to Avoid

• Avoid using high-potency topical steroids for extended periods, which can cause skin atrophy and worsen fungal infections 2
• Avoid inadequate drying of the area before applying medications 2
• Avoid occlusive ointments that may trap moisture and worsen the condition 2
• Don't discontinue treatment prematurely when symptoms improve; complete the full course to prevent recurrence 3

The combination of appropriate antifungal therapy and keeping the area dry is crucial for successful treatment of cutaneous candidiasis in skin folds of obese patients. Topical azoles and polyenes have demonstrated excellent efficacy, with the additional benefit of keeping the affected area dry to prevent recurrence.