What is the treatment for yeast excoriation?

Treatment for Yeast Excoriation

For yeast excoriation (vulvar candidiasis with skin breakdown), apply topical azole antifungals (clotrimazole 1% or miconazole 2% cream) to the affected external areas for 7-14 days, combined with a single 150 mg oral dose of fluconazole for concurrent vaginal infection. 1, 2, 3

Diagnosis Confirmation Before Treatment

Before initiating therapy, confirm the diagnosis through:

• Wet mount preparation using saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1
• Vaginal pH testing - should be normal (4.0-4.5) in candidal infections 1
• Vaginal cultures if wet mount is negative but clinical suspicion remains high 1

The clinical presentation typically includes vulvar edema, erythema, excoriation, fissures, and thick white vaginal discharge, along with pruritus and burning 1

Treatment Algorithm Based on Severity

For Mild to Moderate Excoriation

• Topical azole cream (clotrimazole 1%, miconazole 2%, or butoconazole 2%) applied to external affected areas for 7-14 days 2, 3
• Plus oral fluconazole 150 mg as a single dose for concurrent vaginal infection 1
• No single topical agent demonstrates superiority over others 1, 2

For Severe Excoriation or Complicated Infection

• Topical azole therapy for 7-14 days to external areas 1, 3
• Plus fluconazole 150 mg orally every 72 hours for a total of 2-3 doses 1, 3
• Complicated infection is defined as severe disease, recurrent episodes, non-albicans species, or infection in immunocompromised hosts 1

Special Considerations for Treatment-Resistant Cases

If Initial Treatment Fails

Consider non-albicans Candida species, particularly C. glabrata, which may not respond to standard azole therapy 1, 2:

• Boric acid 600 mg in gelatin capsule intravaginally daily for 14 days 1, 3
• Nystatin intravaginal suppositories 100,000 units daily for 14 days 1, 3
• Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream for 14 days (requires compounding) 1, 3

For Recurrent Vulvovaginal Candidiasis (≥4 episodes/year)

• Induction therapy: 10-14 days with topical azole or oral fluconazole 1
• Maintenance therapy: Fluconazole 150 mg weekly for 6 months 1, 3
• This achieves control in >90% of patients 1

Critical Pitfalls to Avoid

Do not treat sexual partners unless they have symptomatic balanitis with erythema and pruritus 2

Do not use azole/steroid combination creams for initial treatment despite their higher short-term clinical cure rates, as they are not recommended in clinical guidelines and may mask underlying infection 1

Do not assume treatment failure means resistance - verify compliance, confirm the diagnosis, and rule out non-albicans species before escalating therapy 1

Treatment Efficacy

Both topical and oral antifungal formulations achieve >90% response rates for uncomplicated infections 1, 3. Treatment outcomes do not differ based on HIV status 1, 3. The combination of topical therapy for external excoriation with oral therapy for vaginal infection addresses both components of the clinical presentation effectively 3.