What is the treatment for Candidiasis cutis?

Treatment of Cutaneous Candidiasis

For cutaneous candidiasis (candidal skin infections), apply topical azole antifungals such as clotrimazole 1% cream or miconazole 2% cream twice daily for 7-14 days, along with keeping the affected area dry. 1, 2

First-Line Topical Treatment Options

The following topical agents demonstrate equivalent efficacy with complete cure rates of 73-100%: 3

• Clotrimazole 1% cream: Apply twice daily for 7-14 days 2, 4
• Miconazole 2% cream: Apply twice daily for 7-14 days 1, 4
• Nystatin cream or powder: Apply 2-3 times daily for 7-14 days 1, 4, 5

All three agents are equally effective as first-line therapy, and the choice can be based on availability and patient preference. 3 Single-drug antifungal therapy is as effective as combination products containing antifungals plus antibacterials or corticosteroids. 3

Critical Adjunctive Measure

Keeping the infected area dry is essential for treatment success. 1, 2, 4 This is particularly important in skin fold infections (intertrigo), which commonly occur in obese and diabetic patients. 1, 2

Practical drying strategies:

• Use absorbent powders (such as cornstarch) to maintain dryness 4
• For very moist lesions, nystatin topical dusting powder is preferred over creams 5
• Clean affected areas with gentle pH-neutral cleansers and thoroughly dry afterward 4
• Consider barrier protection such as zinc oxide after the area is completely dry 4

Expected Treatment Response

Improvement in signs and symptoms typically occurs within 48-72 hours of initiating therapy, with mycological cure in 4-7 days. 2 However, complete the full 7-14 day course to prevent recurrence.

Systemic Therapy for Refractory Cases

If topical treatment fails after 2 weeks, consider oral fluconazole 150-200 mg daily for 7-14 days. 4 Oral fluconazole demonstrates similar efficacy to topical clotrimazole and is the only commercially available evidence-based option for systemic treatment of cutaneous candidiasis. 3

Special Populations

Neonates with Disseminated Cutaneous Candidiasis

• Healthy, term infants: Topical therapy alone is appropriate 1
• Premature, low-birth weight neonates, or those with prolonged rupture of membranes: Consider systemic therapy with amphotericin B 0.5-1 mg/kg/day for a total dose of 10-25 mg/kg to prevent progression to invasive candidiasis 1

Prevention of Recurrence

• Maintain skin dryness, especially in intertriginous areas 2
• Control underlying conditions such as diabetes 2
• Consider absorbent cotton undergarments 4
• For recurrent infections, intermittent prophylactic use of topical antifungals in prone areas may be beneficial 2, 4
• Weight loss should be encouraged in obese patients as a long-term strategy 4

Common Pitfalls to Avoid

• Do not use high-potency topical corticosteroids for extended periods, as they cause skin atrophy and worsen fungal infections 4
• Do not use occlusive ointments that trap moisture and worsen the condition 4
• Do not apply medications to inadequately dried skin 4
• Do not assume positive Candida culture alone indicates infection, as Candida species are normal skin inhabitants; microscopic observation of mycelial forms is required for diagnosis 6

Non-albicans Candida Species

For infections caused by non-albicans Candida species (such as C. glabrata) that don't respond to azoles, consider alternative topical treatments such as boric acid or topical flucytosine. 1, 4 Nystatin may be particularly useful for non-albicans species, as it maintains consistent MIC90 values across different Candida species. 7