Cutaneous Candidiasis (Intertrigo)
A rash in the groin area being treated with nystatin powder is called cutaneous candidiasis, specifically intertriginous candidiasis or candidal intertrigo. 1
Clinical Presentation
- The groin is a common site for candidal skin infections, particularly in obese and diabetic patients 1
- Typical features include pruritus, erythema, and satellite lesions in warm, moist skin folds 1
- The infection thrives in areas where skin surfaces touch, creating a warm, moist environment 1
Diagnosis Confirmation
- Diagnosis should be confirmed by visualization of yeast or pseudohyphae in wet preparations with 10% KOH or positive culture 2
- Clinical presentation alone may be misleading, as other conditions can mimic candidal infections 2
Treatment Considerations with Nystatin
While nystatin powder is commonly used for groin candidiasis, topical azole antifungals (such as clotrimazole or miconazole) are actually more effective than nystatin and should be considered first-line therapy. 1, 2
Current Treatment Approach
- If using nystatin powder, ensure the area is clean and dry before application 1
- Continue treatment for 7-14 days until complete resolution 1
- Keeping the infected area dry is a critical component of successful treatment 1
When to Switch Therapy
- The CDC and IDSA recommend switching to topical azole agents (clotrimazole or miconazole) if no improvement is seen with nystatin powder 1
- Topical azoles achieve 80-90% cure rates compared to lower efficacy with nystatin 3
- Consider systemic antifungals if there is no improvement after 7-14 days of appropriate topical therapy with moisture control 1
Escalation Strategy
- For complicated or extensive infections that don't respond to topical therapy, oral fluconazole 100-200 mg daily may be required 1
- Addressing underlying risk factors such as diabetes, obesity, or immunosuppression is important for preventing recurrence 1