Treatment for Fungal Infection Under the Breast
For uncomplicated fungal infection under the breast (intertriginous candidiasis), apply topical azole antifungals such as clotrimazole or miconazole cream twice daily for 2-4 weeks while keeping the area dry. 1
First-Line Topical Therapy
Topical azole antifungals are the primary treatment, with clotrimazole cream or miconazole cream applied twice daily for 2-4 weeks being equally effective options. 1
Nystatin cream serves as an alternative polyene option if azoles are not tolerated or unavailable. 1
No single topical agent has demonstrated superiority over others for superficial candidal infections, so choice can be based on availability and cost. 1
Fungicidal agents like allylamines (terbinafine) are generally preferred for dermatophyte infections, but azoles remain the standard for Candida species affecting skin folds. 2
Essential Adjunctive Measures
Keeping the infected area dry is critical for treatment success, as moisture accumulation under the breast promotes fungal growth and treatment failure. 1
Apply absorbent powder or barrier creams after the antifungal application to maintain dryness throughout the day. 1
Address predisposing factors including diabetes, obesity, or excessive moisture to prevent recurrence after treatment completion. 1
When to Escalate to Oral Therapy
Oral fluconazole 100-200 mg daily for 7-14 days is indicated for moderate to severe cutaneous candidiasis or when topical therapy fails after 2-4 weeks. 1, 3
Consider systemic therapy when the infection covers an extensive area or involves multiple skin fold sites. 4
Oral fluconazole has minimal toxicity and is the preferred systemic agent for cutaneous candidiasis. 5
Common Pitfalls to Avoid
Patients often discontinue treatment when the skin appears healed (typically after one week), but this leads to recurrence if the full 2-4 week course is not completed. 2
Failing to address moisture control and predisposing factors results in high recurrence rates even with appropriate antifungal therapy. 1
Using combination antifungal/steroid preparations should be done cautiously and only when significant inflammation is present, as prolonged use can cause skin atrophy. 4