What are the key signs and considerations for a physical exam of a patient with candidiasis interigo?

Physical Examination Findings in Candidal Intertrigo

Candidal intertrigo presents as erythematous, moist skin lesions in body folds with characteristic satellite pustules or papules at the periphery, which is the pathognomonic feature distinguishing it from other causes of intertrigo. 1

Primary Examination Findings

Location and Distribution

• Examine all opposing skin surfaces and natural body folds, including inframammary areas, axillae, groin, intergluteal cleft, abdominal pannus folds, and toe web spaces 1, 2
• In obese patients, inspect obesity-created folds that may not be immediately visible 3, 2

Characteristic Lesions

• Look for bright red or beefy-red erythematous patches with sharply demarcated borders in the affected skin folds 1
• Identify satellite lesions—small discrete pustules or papules located at the periphery of the main erythematous area—which are diagnostic of candidal infection 1
• Observe for peripheral scaling at the edges of the erythematous patches 1
• Note any maceration, fissuring, or weeping of the skin surface, indicating moisture accumulation and skin breakdown 1, 2

Secondary Changes

• Assess for erosions or denuded areas where the epidermis has broken down from friction and moisture 2
• Check for white, curd-like material or exudate in severe cases 3
• Examine for signs of bacterial superinfection, which may present as honey-colored crusting (streptococcal) or coral-red fluorescence under Wood's lamp (Corynebacterium minutissimum) 1

Systematic Examination Approach

Patient Positioning

• Have the patient stand or lie in positions that allow full visualization of all skin folds 2
• Gently separate folds to inspect the deepest recesses where moisture accumulates 2

Associated Findings

• Document any malodor, which suggests bacterial superinfection or severe maceration 2
• Palpate for tenderness or pain, as candidal intertrigo causes significant discomfort and itching 3
• Note the temperature and moisture level of affected areas 2

Diagnostic Confirmation During Examination

Physical examination alone is usually sufficient for clinical diagnosis when satellite lesions are present, but confirmation with potassium hydroxide (KOH) preparation should be performed in atypical or treatment-resistant cases. 1

• Obtain skin scrapings from the active border and satellite lesions for KOH microscopy, which will reveal pseudohyphae and budding yeast 1
• Consider bacterial culture or Wood's lamp examination if bacterial superinfection is suspected 1

Common Pitfalls to Avoid

• Do not rely solely on erythema without satellite lesions—simple intertrigo from friction alone appears similar but lacks the characteristic peripheral pustules that indicate candidal infection 1
• Do not miss examining all body folds—candidal intertrigo commonly affects multiple sites simultaneously, and untreated reservoirs lead to recurrence 3
• Do not confuse with inverse psoriasis, which has well-demarcated plaques but lacks satellite lesions and has a different texture 1
• In immunocompromised or diabetic patients, examine carefully for deeper tissue involvement or systemic signs, as these populations are at higher risk for invasive disease 3, 4