What is the treatment for panus (fungal) yeast infections?

Treatment of Panus (Panniculitis) Yeast Infections

For yeast infections in skin folds (intertrigo/panniculitis), apply topical azole antifungals such as clotrimazole 1% cream or miconazole 2% cream twice daily for 7-14 days, with keeping the area dry being equally critical to treatment success. 1

First-Line Topical Treatment

• Topical azole antifungals are the recommended first-line therapy, including clotrimazole 1% cream, miconazole 2% cream, or nystatin cream/ointment applied to affected areas 1
• These agents demonstrate proven effectiveness for nonhematogenous primary skin candida infections occurring as intertrigo in skin folds 1
• Treatment duration is 7-14 days depending on severity and clinical response 1
• Application should be twice daily to the affected area and surrounding skin 2

Critical Adjunctive Measures (Equally Important as Medication)

• Keeping the infected area dry is critically important for treatment success and may be as important as the antifungal agent itself 1
• This is particularly crucial in obese and diabetic patients who are at higher risk for these infections 1
• Consider using absorbent powders (not antifungal powders alone) after applying cream to maintain dryness 2

Choosing Between Fungicidal vs Fungistatic Agents

• Azole drugs (clotrimazole, miconazole, ketoconazole) are fungistatic, limiting fungal growth but depending on epidermal turnover to shed the fungus 2
• Allylamines (terbinafine, naftifine, butenafine) are fungicidal, actually killing fungal organisms and may be preferred for dermatophytic infections 2
• However, yeast infections caused by Candida species respond better to azole drugs rather than allylamines 2
• For panniculitis yeast infections specifically, azoles remain the preferred choice 1

When Oral Therapy May Be Needed

• Widespread infections involving large body surface areas may require systemic treatment rather than topical therapy alone 2
• Fluconazole 150 mg as a single dose can be considered for extensive cutaneous candidiasis, though this is more commonly used for vulvovaginal candidiasis 3
• Chronic or recurrent infections in immunocompromised patients may require prolonged oral antifungal therapy 4

Common Pitfalls to Avoid

• Do NOT stop treatment when skin appears healed (usually after about 1 week) - complete the full 7-14 day course to prevent recurrence 2
• Do NOT use topical therapy alone for nail fold infections (paronychia) - these require specific management approaches 5
• Do NOT neglect the underlying predisposing conditions such as obesity, diabetes, or moisture accumulation - recurrences are frequent if these are not addressed 1, 4
• Do NOT confuse skin fold candidiasis with vulvovaginal candidiasis, which requires different treatment approaches 1

Special Considerations for High-Risk Patients

• Immunocompromised patients may require longer treatment courses and closer monitoring 6
• Patients with diabetes require optimization of glucose control to prevent recurrence 1
• Consider spray formulations for weeping infections as patients often prefer these 2