From the Guidelines
The best over-the-counter (OTC) treatment for mucocutaneous candidiasis is Clotrimazole 1% cream or Miconazole 2% cream, applied intravaginally for 7-14 days or 7 days, respectively, as recommended by the 2021 Centers for Disease Control and Prevention (CDC) treatment guidelines 1.
Treatment Options
- Clotrimazole 1% cream: 5 g intravaginally daily for 7-14 days
- Clotrimazole 2% cream: 5 g intravaginally daily for 3 days
- Miconazole 2% cream: 5 g intravaginally daily for 7 days
- Miconazole 4% cream: 5 g intravaginally daily for 3 days ### Rationale The CDC guidelines provide evidence-based recommendations for the treatment of vulvovaginal candidiasis (VVC), which is a type of mucocutaneous candidiasis. While the guidelines do not specifically address mucocutaneous candidiasis, the recommended treatments for VVC can be applied to other forms of mucocutaneous candidiasis. The guidelines recommend OTC intravaginal agents, such as Clotrimazole and Miconazole, as first-line treatments for VVC.
Important Considerations
It is essential to note that microscopy and clinical diagnosis have poor sensitivity, and yeast cultures can lead to a delay in diagnosis and treatment. Therefore, many providers rely on microscopy or clinical diagnosis for patients presenting with symptoms consistent with VVC. However, this approach may result in misdiagnosis and unnecessary treatment. Molecular testing, such as polymerase chain reaction (PCR), has been shown to have high clinical accuracy for diagnosing VVC 1.
From the Research
Treatment Options for Mucocutaneous Candidiasis
- Topical antifungal agents are the primary treatment for cutaneous candidiasis, with clotrimazole, nystatin, and miconazole being the most studied and effective options, demonstrating complete cure rates of 73%-100% 2
- Azole antifungal creams, such as bifonazole, ketoconazole, and luliconazole, are also effective in treating cutaneous candidiasis 3
- Terbinafine hydrochloride and amorolfine hydrochloride are additional topical treatment options for cutaneous candidiasis 3
- Oral therapy with itraconazole is recommended for candidal paronychia and onychomycosis, and itraconazole oral solution is commonly used for oral candidiasis 3
- Systemic antifungal treatment, such as oral fluconazole, can be effective in treating cutaneous candidiasis, but may be followed by rapid relapse 2, 4, 5
- Combination therapy, including systemic antifungal treatment and immunotherapy, may be the most promising approach for chronic mucocutaneous candidiasis 4, 6, 5
Treatment Duration and Relapse
- Cutaneous candidiasis typically requires a shorter duration of topical treatment (1-2 weeks) compared to superficial dermatophyte infections 3
- Fungal infections in patients with chronic mucocutaneous candidiasis often relapse shortly after treatment is stopped, unless the underlying immunologic defects are corrected 4, 5