Treatment of Fungal Infection Under the Breast
For a fungal infection under the breast (intertriginous candidiasis), apply a topical azole antifungal cream (such as clotrimazole, miconazole, or ketoconazole) twice daily to the affected area, keeping the skin fold dry, for 2-4 weeks until complete resolution.
First-Line Topical Therapy
The infection under the breast represents intertrigo caused by Candida species, which occurs in skin folds, particularly in obese and diabetic patients 1. This is a form of nongenital mucocutaneous candidiasis that responds well to topical treatment 1.
Recommended Topical Agents
- Clotrimazole cream: Apply to affected area twice daily 1
- Miconazole cream: Apply to affected area twice daily 1
- Ketoconazole cream: Apply to affected area twice daily 2
- Nystatin cream: Apply to affected area 2-4 times daily 1
All of these agents are effective for cutaneous Candida infections 1. The azole drugs (clotrimazole, miconazole, ketoconazole) are fungistatic and particularly effective against yeast infections like Candida 2.
Critical Adjunctive Measures
Keeping the infected area dry is the most important intervention alongside antifungal therapy 1. This addresses the underlying predisposing factor of moisture accumulation in the skin fold.
Practical strategies include:
- Thoroughly drying the area after bathing 1
- Using absorbent powder (non-medicated) to reduce moisture 3
- Wearing loose-fitting, breathable clothing 3
- Placing clean, dry cloth or gauze between skin folds if needed 3
Duration of Treatment
- Continue treatment for 7-14 days for uncomplicated nongenital mucocutaneous candidiasis 1
- Extend to 2-4 weeks if the infection is extensive or slow to respond 4
- Continue for at least one week after clinical clearing to prevent recurrence 4
When to Consider Systemic Therapy
If the infection is widespread, involves extensive areas, or fails topical therapy, oral fluconazole is indicated 5:
- Fluconazole 100-200 mg daily for 7-14 days for refractory or extensive nongenital mucocutaneous candidiasis 1
- This represents step-up therapy when topical agents are insufficient 1
Common Pitfalls to Avoid
Do not use allylamine antifungals (terbinafine, naftifine, butenafine) for this condition, as yeast infections like Candida respond less well to these agents compared to azoles 2. Allylamines are preferred for dermatophyte infections, not Candida 2.
Do not use combination antifungal/steroid preparations unless significant inflammation is present, as steroids can cause skin atrophy and other complications with prolonged use 4. If inflammation is severe, use these combination products cautiously and for limited duration 4.
Address underlying risk factors: Obesity, diabetes, and excessive moisture are key predisposing factors 1, 3. Poor glycemic control in diabetic patients will lead to treatment failure and recurrence 3.