What is a yeast rash?

What is a Yeast Rash?

A yeast rash is a fungal skin infection caused by Candida species (most commonly Candida albicans) that presents as erythematous (red), moist plaques with characteristic satellite lesions—small, discrete pustules or papules surrounding the main area of involvement. 1, 2

Clinical Presentation

The hallmark features that distinguish a yeast rash include:

• Erythematous (red) plaques with satellite lesions: The primary rash appears as red, inflamed patches with small surrounding pustules or papules that extend beyond the main affected area 1, 2
• Location in moist, macerated skin: Yeast rashes typically develop in intertriginous areas (skin folds) where moisture accumulates, including under breasts, in the groin, between buttocks, and in axillae 1
• Associated symptoms: Pruritus (itching), burning sensation, and soreness are common 1, 3

Specific Manifestations by Location

Mucocutaneous candidiasis can present in several distinct forms:

• Intertrigo: Infection in skin folds with red, moist plaques 1
• Thrush: White patches on oral mucosa 1, 4
• Paronychia: Infection around nail beds 1
• Vulvovaginal candidiasis: White, thick "cottage cheese-like" discharge with vulvar erythema and edema 2, 3
• Balanitis: Penile involvement 1

Diagnostic Confirmation

While visual inspection may suggest yeast infection, confirmation requires:

• Potassium hydroxide (KOH) preparation: Microscopic examination of skin scrapings with 10% KOH reveals yeasts, pseudohyphae, or true hyphae 1, 2
• Culture: When microscopy is negative or treatment fails, fungal culture with speciation identifies the causative organism 1

Predisposing Factors

Yeast rashes develop when normal host defenses are compromised:

• Moisture and maceration: Prolonged skin wetness creates ideal fungal growth conditions 1
• Antibiotic or corticosteroid use: These medications disrupt normal flora balance, allowing yeast overgrowth 1, 5
• Immunocompromised states: HIV infection, neutropenia, diabetes, and other conditions increase susceptibility 1, 5
• Limited mobility: Patients with restricted movement (e.g., nursing home residents) are at higher risk due to persistent moisture in skin folds 6

Important Clinical Pitfall

In immunocompromised patients, cutaneous yeast lesions may indicate disseminated candidiasis. Approximately 10-13% of patients with invasive candidemia develop skin manifestations that appear as discrete pink-to-red papules (0.5-1.0 cm) on the trunk and extremities, which may become hemorrhagic if thrombocytopenic 1, 7. These patients require blood cultures and systemic antifungal therapy, not just topical treatment 1, 7.

Treatment Approach

For localized cutaneous candidiasis:

• Topical azole antifungals are first-line therapy (clotrimazole, miconazole, ketoconazole) applied to affected areas 1, 2
• Keep skin dry: Moisture control is essential for treatment success and prevention 1

For vulvovaginal candidiasis specifically, either topical azoles for 1-7 days or oral fluconazole 150 mg single dose achieves >90% efficacy 2, 3.

Common Misdiagnosis to Avoid

Not all rashes in moist areas are yeast infections. The characteristic satellite lesions distinguish candidal rash from:

• Bacterial intertrigo (lacks satellite lesions)
• Contact dermatitis (different distribution pattern)
• Decubitus ulcers in immobile patients (as illustrated in one case where a sacral lesion was initially misdiagnosed as pressure ulcer but proved to be Candida tropicalis infection) 6