What is the treatment for skin candida?

Treatment of Cutaneous Candidiasis

For cutaneous Candida infections, use topical azoles (clotrimazole or miconazole) or nystatin applied 1-2 times daily for 1-2 weeks, and keep the affected area dry. 1, 2

First-Line Topical Therapy

• Topical azoles (clotrimazole, miconazole) or polyenes (nystatin) are equally effective with complete cure rates of 73-100% for candidal skin infections 2, 3
• Apply once or twice daily for 1-2 weeks depending on severity and location 1, 2
• These agents work by direct contact with the fungus and require simultaneous presence for adequate duration 4

Site-Specific Management

Intertrigo (Skin Fold Infections)

• Use topical azoles or nystatin as first-line treatment 1, 2
• Keeping the infected area dry is equally important as antifungal therapy - this addresses the moisture that promotes fungal growth 1, 2
• Common in obese and diabetic patients who require attention to predisposing factors 1

Candidal Paronychia (Nail Fold Infection)

• Drainage is the most important intervention 1, 2
• Combine drainage with topical antifungal therapy 2
• This differs from onychomycosis where the nail plate itself is infected 1

Candidal Onychomycosis (Nail Plate Infection)

• Topical agents alone are usually ineffective due to poor penetration through the nail plate 5
• Oral itraconazole is the first-line systemic treatment - given as 200 mg daily or pulse therapy (400 mg daily for 1 week each month) for minimum 4 weeks for fingernails or 12 weeks for toenails 1, 2
• Fluconazole (50 mg daily or 300 mg weekly) is an alternative if itraconazole is contraindicated 1
• Itraconazole demonstrates superior cure rates (92%) compared to terbinafine (40-60%) for Candida nail infections 1

When to Consider Systemic Therapy

• Oral fluconazole is reserved for extensive disease, immunocompromised patients, or treatment failures 3
• Fluconazole demonstrates similar efficacy to topical clotrimazole but is typically unnecessary for localized cutaneous infections 3
• Single-drug topical therapy is as effective as combinations with antibacterials or corticosteroids 3

Common Pitfalls to Avoid

• Do not use terbinafine for Candida infections - allylamines have limited activity against yeasts and are preferred for dermatophyte infections only 5
• Avoid premature discontinuation - patients often stop when skin appears healed (typically after 1 week), but this can lead to recurrence with fungistatic agents like azoles 5
• Address underlying predisposing factors (diabetes, obesity, moisture, immunosuppression) to prevent recurrence 1, 4

Treatment Algorithm Summary

1. Localized cutaneous Candida: Topical azole or nystatin × 1-2 weeks + keep area dry 1, 2
2. Intertrigo: Same as above with emphasis on drying skin folds 1, 2
3. Paronychia: Drainage first, then topical antifungal 1, 2
4. Onychomycosis: Oral itraconazole (pulse or continuous) for 4-12 weeks 1, 2
5. Extensive/refractory disease: Consider oral fluconazole 3