Cutaneous and mucosal candidiasis is an acute, subacute, or chronic inflammation of the skin and mucous membranes caused by Candida. Candida is widely distributed in nature and normally present in the human oral cavity, gastrointestinal tract, vaginal mucosa, and skin. When the body's resistance is weakened or microbial balance is disrupted, Candida can proliferate and cause disease, making it an opportunistic pathogen. Among these, Candida albicans is the primary pathogenic species. Factors such as infant malnutrition, malignant tumors, diabetes mellitus, prolonged use of corticosteroids, immunosuppressants, and broad-spectrum antibiotics can easily trigger this condition.

bubble_chart Clinical Manifestations

1. Cutaneous Candidiasis
   1. Intertriginous Candidiasis: Well-defined erythema occurs in areas such as the armpits, under the breasts, groin, buttocks, and between fingers, presenting as macerated erosions or tiny chickenpox-like pustules.
   2. Candidal Paronychia and Onychomycosis: Redness and swelling around the nails without suppuration. The nail plate thickens, with an uneven surface that may have white or brown-black spots but retains some luster.
   3. Generalized Cutaneous Candidiasis: Often seen in malnourished infants or those with chronic diarrhea. The lesions consist of dense, pinhead- to mung bean-sized red papules or large confluent patches, with possible erosions and exudates, commonly found in skin folds.
2. Mucous Membrane Candidiasis
   1. Oral Mucous Membrane Candidiasis (Thrush): Frequently occurs in patients on long-term antibiotics or steroids. The oral mucosa and tongue are covered with patchy white membranes.
   2. Candidal Vaginitis: Common in diabetic and pregnant women. The vaginal mucosa is covered with thin white membranes, and discharge resembles tofu dregs, accompanied by intense cutaneous pruritus.
   3. Candidal Balanoposthitis: Often associated with sexually transmitted infections. Pinhead- to foxtail millet-sized papules or small pustules appear on the glans, coronal sulcus, and inner foreskin, which may develop into erosions covered with abundant white, cheese-like membranes, causing severe itching.
   4. Candidal Angular Cheilitis: Redness, erosions, and rhagades at the corners of the mouth.

bubble_chart Diagnosis

1. It is prone to occur in patients with compromised immune systems, such as those with malignant tumors, diabetes, long-term use of hormones, or immunosuppressants;
2. The clinical manifestations and skin lesion characteristics of various clinical types;
3. Direct microscopic examination of skin scales or secretions reveals spores and pseudohyphae, and Candida culture is positive (three or more times with the same species).

bubble_chart Treatment Measures

Treatment Principles

1. Primarily use topical antifungal agents;
2. if necessary, take systemic antifungal medications;
3. actively treat the underlying condition and eliminate contributing factors.

1. For candidiasis localized to the skin or mucous membranes, topical therapy is the main approach;
   1. for cutaneous or balanitis candidiasis, apply imidazole creams;
   2. for aphthae, choose clotrimazole or nystatin buccal tablets, or apply 1% Chinese Gentian Violet or rinse with a 3% sodium bicarbonate solution;
   3. for vaginal candidiasis, rinse with a 3% sodium bicarbonate solution before inserting antifungal suppositories.
2. For stubborn, recurrent local infections or systemic infections, oral systemic antifungal drugs such as fluconazole or itraconazole may be used;
3. if accompanied by systemic diseases like malignant tumors or diabetes, treat these concurrently.

bubble_chart Cure Criteria

1. Cure: Skin lesions and symptoms subside, with negative results in direct microscopic examination and culture for Candida once a month for three consecutive times;
2. Improvement: Partial subsidence of skin lesions and alleviation of symptoms, with negative or positive results in Candida examination;
3. No cure: No improvement in skin lesions or symptoms, with positive results in Candida examination.