What is the treatment for skin candida?

Treatment of Skin Candida

For cutaneous candidiasis, topical azole antifungals (clotrimazole, miconazole) or polyenes (nystatin) are the first-line treatment, with complete cure rates of 73-100%, and keeping the infected area dry is equally critical to successful treatment. 1, 2

First-Line Topical Therapy

Apply topical antifungal agents to affected areas 1-2 times daily for 7-14 days:

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

All three agents demonstrate similar efficacy with complete cure rates of 73-100% in clinical trials 2. Single-drug therapy is as effective as combination products containing antifungal, antibacterial, and topical corticosteroid 2.

Essential Adjunctive Measures

Keeping the infected area dry is critically important and must be emphasized to patients:

• Use absorbent powders such as cornstarch (avoid talc) to maintain dryness 3, 4
• Clean affected areas with gentle pH-neutral cleansers and thoroughly dry afterward 3
• Apply barrier protection such as zinc oxide after the area is completely dry to prevent moisture reaccumulation 3, 4
• For intertrigo in skin folds (especially in obese or diabetic patients), moisture control is as important as antifungal therapy 1

Management of Inflammation

For cases with significant surrounding inflammation:

• Short-term use of low-potency topical corticosteroids (hydrocortisone 1%) combined with antifungal therapy can reduce inflammation 4
• Combination products containing both antifungal and mild corticosteroid may be used for brief periods 3, 4
• Avoid high-potency topical steroids for extended periods, as they cause skin atrophy and can worsen fungal infections 3, 4

Systemic Therapy for Resistant or Extensive Disease

When topical treatment fails after 2 weeks or for extensive disease:

• Oral fluconazole 150-200 mg daily for 7-14 days is the evidence-based systemic option 1, 3, 2
• Oral fluconazole demonstrates similar efficacy to topical clotrimazole and is the only commercially available evidence-based systemic treatment 2
• For non-albicans Candida species (C. glabrata, C. krusei) that don't respond to azoles, consider topical boric acid 1, 3

Site-Specific Considerations

Candidal paronychia (nail fold infection):

• Drainage is the most important intervention 1, 5
• Combine drainage with topical antifungal therapy 5

Candidal onychomycosis (nail infection):

• Topical agents alone are usually ineffective 5
• Oral itraconazole is recommended for nail infections 5, 6
• Note that terbinafine has limited and unpredictable activity against Candida onychomycosis 1

Prevention of Recurrence

• Maintain good hygiene and keep skin folds dry 3
• Use absorbent cotton undergarments 3
• For recurrent infections, intermittent prophylactic use of topical antifungals may be beneficial 3
• Address predisposing factors such as diabetes, obesity, or immunosuppression 1, 6

Common Pitfalls to Avoid

• Do not use occlusive ointments that trap moisture and worsen the condition 3, 4
• Do not apply medications to inadequately dried skin - this is a frequent cause of treatment failure 3, 4
• Do not use high-potency corticosteroids for prolonged periods as they cause skin atrophy and promote fungal growth 3, 4
• Do not assume positive Candida culture equals infection - Candida is a normal skin inhabitant, and microscopic examination showing mycelial forms is required for diagnosis 6