Distinguishing and Treating Tinea Corporis vs Candida Intertrigo
For tinea corporis, use topical terbinafine or naftifine as first-line therapy for 2 weeks; for candida intertrigo, use topical azole antifungals (clotrimazole, miconazole) or nystatin with attention to moisture control and predisposing factors.
Clinical Diagnosis
Tinea Corporis Presentation
- Well-demarcated, sharply circumscribed, oval or circular patches with raised, scaly leading edges and central clearing creating the classic "ringworm" appearance 1
- Mild pruritus is common 1
- Lesions typically appear on exposed skin surfaces of the trunk and extremities 2, 3
- Scaling, cracking, and burning may accompany the infection 2
Candida Intertrigo Presentation
- Occurs in opposing skin folds (inframammary, axillary, inguinal, intergluteal areas) where moisture accumulates 4
- Presents as erythematous, macerated patches with satellite pustules at the periphery (key distinguishing feature) 4
- Pain and itching are prominent symptoms that significantly decrease quality of life 4
- Lacks the raised, scaly border characteristic of tinea 4
Diagnostic Confirmation
- KOH preparation is the primary diagnostic tool for both conditions: scrape the active border for tinea corporis; sample the central erythematous area for candida 3, 1
- Tinea shows branching hyphae on microscopy; candida shows budding yeasts with pseudohyphae 5, 3
- Fungal culture is the gold standard when diagnosis is uncertain, infection is resistant to treatment, or widespread 1
- Dermoscopy can be useful as a non-invasive diagnostic tool for tinea corporis 1
Treatment Approach
Tinea Corporis Treatment
Topical therapy is first-line for localized disease:
- Terbinafine 1% cream once or twice daily for 2 weeks is highly effective (NNT 3) and FDA-approved 2, 3, 6
- Naftifine 1% cream once or twice daily for 2 weeks is similarly effective (NNT 3) 6
- Azoles (clotrimazole 1%, miconazole) twice daily for 2 weeks are alternative options (NNT 2 for clotrimazole) 3, 6
- Continue treatment for at least 1 week after clinical clearing to prevent relapse 3
Systemic therapy indications:
- Multiple, extensive, deep, recurrent, or chronic lesions 1
- Unresponsive to topical treatment 1
- Immunodeficient patients 1
- Fluconazole 150 mg once weekly for 2-4 weeks is an effective oral option 7
Candida Intertrigo Treatment
Address predisposing factors first (critical for preventing recurrence):
- Weight loss in obese patients 4
- Optimize diabetes control 4
- Manage immunosuppressive conditions 4
- Treat intestinal colonization or periorificial candida infections 4
- Keep affected areas dry - this is essential and non-negotiable 4
Topical antifungal therapy:
- Nystatin cream or azole antifungals (clotrimazole, miconazole) applied 2-3 times daily until resolution 5, 4
- Magistral remedies (compounded preparations) can be used safely and effectively 4
- Treatment duration typically 2-4 weeks depending on response 5
Systemic therapy indications:
- Generalized infections 4
- Predisposing immunosuppressive conditions 4
- Recurrent or treatment-resistant cases 4
- Fluconazole 100-200 mg daily is the standard systemic option 5
Critical Pitfalls to Avoid
- Do not use topical corticosteroids alone - while azole/steroid combinations show higher short-term clinical cure rates, they can mask the diagnosis and cause atrophy with prolonged use 6
- Prior use of calcineurin inhibitors or corticosteroids makes clinical diagnosis of tinea corporis difficult; obtain KOH or culture in these cases 1
- Failure to address moisture and predisposing factors in candida intertrigo leads to high recurrence rates regardless of antifungal choice 4
- Tinea cruris (jock itch) may be confused with candida intertrigo; look for the raised scaly border and absence of satellite lesions to distinguish tinea 3, 6
- Inadequate treatment duration (stopping when lesions appear clear) is a common cause of relapse in tinea corporis 3