Clinical Description of Candidal Rash in Abdominal Pannus
A candidal rash in the abdominal pannus presents as bright erythema with fragile papulopustules and characteristic satellite lesions at the periphery, accompanied by maceration and moisture in the affected skin fold, often with white or creamy exudate in severe cases. 1, 2
Primary Clinical Features
The hallmark presentation includes:
- Bright erythematous patches that are moist and well-demarcated within the pannus fold 1, 2
- Satellite pustules at the periphery of the main erythematous area, which is pathognomonic for candidal infection 1, 2
- Maceration of skin in the affected fold due to moisture accumulation and reduced air circulation 1
- White or creamy exudate in more severe cases 1
- Pruritus and burning sensation as prominent symptoms 1
Key Distinguishing Characteristics
The diagnosis is primarily clinical, though several features help differentiate candidal intertrigo from other conditions:
- Fragile papulopustules that rupture easily, distinguishing this from bacterial or other fungal infections 2
- Satellite lesions extending beyond the main area of involvement are highly characteristic of Candida 2
- The rash occurs specifically in occluded, macerated areas where moisture and warmth favor fungal proliferation 1, 2
Important Clinical Distinctions
This superficial cutaneous candidiasis represents true mucocutaneous infection requiring treatment, not mere colonization. 1 The presence of symptomatic erythema, pustules, and patient discomfort distinguishes infection from asymptomatic colonization that requires no treatment 3.
When to Suspect Deeper Involvement
While pannus candidiasis is typically superficial, be alert for signs suggesting systemic disease in high-risk patients:
- Persistent fever despite topical treatment in immunocompromised or critically ill patients 3
- Purpuric changes in the rash, which may indicate vascular invasion (though rare in immunocompetent patients) 4
- Nodular lesions rather than simple erythema, which can suggest disseminated candidiasis 5, 4
Diagnostic Confirmation
- Clinical diagnosis is usually sufficient based on the characteristic appearance 1
- Fungal culture should be obtained if diagnosis is uncertain or treatment fails 1
- Gram stain or KOH preparation can identify hyphae and budding yeast, though Candida structures may not grow extensively through the stratum corneum 2
Common Pitfall
Do not confuse colonization with infection. Candida can colonize normal tissue and be a culture contaminant, so consider predisposing factors (occlusion, maceration, diabetes, poor hygiene) and clinical presentation when interpreting positive cultures 2. Treatment is only indicated when there are symptomatic skin changes, not for asymptomatic colonization. 3