Candidiasis of the Skin: Causes, Symptoms, and Treatment

Overview

The human skin is a habitat for different kinds of bacteria and fungus. The majority of them are harmless and are required for the normal functioning of the body. ‘Candida’ is a naturally occurring yeast/fungus, that dwells on the skin and mucosal membranes (lining inside the body structures) of the human body. There are about 200 species of Candida and more than 15 types can lead to infection in humans. The most common type, Candida Albicans (C.Albicans), upon over-growth tends to cause ‘Candidiasis of the skin’. The rapid multiplication of these fungi can also result in an infection to the skin, nails and mucosal membranes across the body.

Most candida infections tend to be local and affect only one body part. However, there are different types of candida infections that tend to affect localized areas as well as internal organs leading to larger illnesses. The various types are Thrush/Oropharyngeal Candidiasis (Candida infections of the mouth/throat), Esophagitis (Candida infections that have spread to the esophagus), Yeast infection (Candida affecting the vagina/glans penis) and Invasive Candidiasis (Candida infection that has spread into the bloodstream, brain, eyes, and other body organs).

The candidiasis of skin is termed as ‘Cutaneous Candidiasis’ and the one infecting the nails is Onychomycosis. Cutaneous Candidiasis cause superficial infections to the skin/mucosal membranes.

The different types that fall into the Candidiasis of the skin/Cutaneous Candidiasis are:

Types of Candidiasis

a.) Intertrigo: The condition causes painful swelling along with redness/rash, that develops between the folds of the skin (body areas such as the armpits, under the breasts, groin, spaces between the digits, abdominal folds or within other fat folds). These skin areas tend to be friction-prone, are moist and warm with constricted airflow, that provides favorable conditions for the abnormal multiplication of C. Albicans fungi.

b.) Diaper Dermatitis: Diaper Dermatitis/Diaper Rash is an irritating condition that develops in the infants/children on the skin area covered by the diaper. It usually occurs in infants aged between 9 to 12 months, or in a child who wears a diaper. This condition causes satellite-like lesions and macerated skin due to overhydration, persistent contact with the urine and feces, topical ingredients and retained soaps in the diaper, which provide favorable conditions for the growth of the yeast (C.Albicans).

c.) Erosion Interdigitalis Blastomycetica (EIB): EIB or Interdigital Candidiasis is candida infection of the hands and feet (particularly web spaces of the fingers/toes). EIB tends to be a common phenomenon in those who are required to work with their hands/feet immersed in water (such as the launderers, home-makers, farmers, slaughterhouse workers, bartenders, and dish-washers.). Individuals wearing rings also tend to retain water around the surface of the digits. These occupational or lifestyle factors lead to exposure of the skin to chronic irritants and moisture, resulting in a breakdown of the epidermal barrier, offering favorable conditions for the growth and colonization of C.Albicans.

Other immuno-suppressive factors (certain diseases like HIV/Aids) that paralyze the immune system are also susceptible to Candida infections. The use of corticosteroids suppresses the immune system, as it reduces the local inflammatory response and cell-regulated immunity, allowing the candida to thrive. EIB tends to be prevalent in patients with Diabetes Mellitus, as the increased glucose levels suppress the Polymorphonuclear Neutrophils (PMS) activity, preventing the immune system from destroying the yeast.

The signs of EIB are characteristic in nature and are usually seen in the areas of friction between the fingers/toes, never extending to the other surface areas of the hand/feet respectively. The infected area is generally round/oval with white macerated tissue, separated from the underneath layer (erythematous layer), that forms a tear between the surrounding tissue (often termed as ‘white collarette of the epidermis’). The tore tissue appears raw, red, eroded and glossy.

d.) Perianal, Perineal, and Intergluteal Candidiasis: These skin areas tend to be naturally moist and provide a flourishing environment for the fungus. Also, it may develop as a result of an extended infection of the vulvovaginal or intestinal candidiasis, spreading out to the perineal regions. Thus, developing marked erythema and macerated skin in the affected area.

e.) Candidal Balanitis: Balanitis is a candida infection, that causes infection and inflammation to the glans penis. It occurs in both, circumcised/uncircumcised men, although more commonly in uncircumcised men with a tight foreskin. The non-retractability of the foreskin results in inadequate hygiene, giving a favorable atmosphere for the yeast to grow. Men with high blood sugar levels tend to release glucose-rich urine, that dribbles on the glans penis/underneath the foreskin, making it a conducive environment for the growth of C.Albicans.

Causes

As C.Albicans is a common habitat of the human body, the factors that cause the yeast to grow and multiply, resulting in different kinds of Cutaneous Candidiasis are briefed in a nutshell as below:

• Weakened Immune System: As the immune system plays a crucial role in combating various infections, any elements that tend to suppress/paralyze the immune system, reduces its capacity to fight invading pathogens.

Therefore, certain health conditions such as HIV/Aids, Cancer, Diabetes, Hyperthyroidism, Addison’s disease, Cushing’s disease, Stress, other skin infections or any of such immuno-suppressive medical ailments tend to provide a favorable atmosphere for multiplication and growth of the yeast.

Medications

As Anti-biotic medications tend to attack the harmful as well as harmless bacteria, the skin becomes susceptible to fungal infections. Antibiotics tend to kill the harmless, essential bacteria that help in regulating the growth of the yeast.

Thus, the yeast which is unaffected by antibiotics, multiply rapidly causing various kinds of Cutaneous Candidiasis. Also, certain steroidal drugs and cancer medication/therapies make the immune system weak, allowing the fungus to proliferate.

Steroidal medicines as well as reduce the cell-regulated immunity, providing an encouraging environment for the yeast to grow and cause infection.

• Obesity: As obese people have excess folds in the skin, yeast tends to thrive in the warm and moist areas between these skin folds (intertriginous areas). The extra accumulated fat results in more sweating, making the skin moist, thus, offering the fungi rich feeding ground to multiply rapidly.

The excess weight exerts and weakens the immune system, due to increasing demands of the body. Thus, reducing its vitality to fight infections.

• Inadequate Diet: As per a few research claims, certain foodstuffs such as Sugar, Dairy products, Gluten, and Alcohol tend to promote the growth of yeast in abnormal quantities.

However, an adequate amount of Candida yeast helps to keep the gut healthy, promoting absorption of nutrients and aiding the digestion process. The disturbed balance due to yeast overgrowth results in Candida infections.

Other factors that contribute to Cutaneous Candidiasis are weather conditions (hot/humid), improper hygiene, frequent exposure to water/irritants, untimely diaper/undergarment changes in infants, uncomfortable tight/synthetic clothing preventing the skin from breathing or damp/wet skin improperly dried.

Symptoms

The following symptoms are observed in patients with Cutaneous Candidiasis:

• The candida infection of the skin primarily causes rash, which results in redness, itching, and often leaky fluid.
• The skin lesions tend to be well-confined to the infected area, which are patches of different sizes/shapes.
• In cases of severe infection, Blisters/Scabs/Pustules can be seen around the borders of the rash. This candida infected lesions can be discomforting, painful and itchy.
• These symptomatic conditions mostly develop in the fat folds of the skin such as the armpits, under the breasts, navel, between the folds of the buttocks, groin area or web spaces between the fingers/toes of hand/feet respectively.

Diagnosis And Treatment

The other skin conditions that resemble Cutaneous Candidiasis are ringworm, herpes, erythrasma, contact/seborrheic dermatitis, pruritus, hives, psoriasis, impetigo, eczema, and diabetes-associated skin ailments. As the clinical features tend to overlap with these skin conditions, the differential diagnosis for Candidiasis of skin tends to be narrow. The physician takes the medical history of the patient to understand, if there are any underlying medical conditions or if the patient is on any medication (such as antibiotics) that is causing the infection.

Though diagnosis can be made based on visual examination, for accurate analysis, the infected area is scraped off by rubbing a cotton swab and tested for positive fungal culture in the laboratory. Also, Potassium Hydroxide (KOH) mount test is essentially carried out to diagnose candida infection of the skin. Candidiasis of the skin can be managed/prevented by:

• Maintaining proper hygiene
• Regular washing and appropriate drying of the skin
• Preventing the skin from becoming moist, avoiding damp clothes
• Wearing comfortable/loose clothing
• Changing socks/undergarments routinely
• Use of mild/unscented soaps
• Avoiding processed/sugar-rich food/dairy products/alcohol
• Increasing the number of probiotics in the diet.

Apart from these precautionary measures, certain natural remedies can be followed to treat the yeast infections of the skin upon consulting the physician as mentioned below:

• As Apple Cider Vinegar has mild acidic properties, it helps to prevent the fungus from spreading, accelerating the recovery process. Mixing 2 tablespoons of vinegar with one cup of lukewarm water and drinking it twice daily is recommended for treating candida infections.

Diluting Apple Cider Vinegar with equal proportions of water and applying or soaking the infected area in the same for about 30 minutes and then pat dry the area thoroughly, can help in treating the yeast rash.

• Garlic has been known for its anti-bacterial properties, however, as per recent research studies, garlic acts as a strong anti-fungal agent too. The added advantage being, it does not destroy the essential bacteria in the gut.

Garlic paste using 2 garlic cloves should be made, and few drops of Olive oil are to be added to the paste. This mixture must be applied to the infected area of the skin, allowing it to stay for 30 minutes. Then the area should be washed off and pat dry thoroughly.

Also, few garlic cloves can be added to the food or garlic supplements can be opted, so as to accelerate the healing process of the yeast infection.

• Coconut Oil is one of the best organic products with innumerable health benefits. It has anti-fungal properties and research studies have strongly claimed its effectiveness against C.Albicans.

The oil can be directly applied to the fungi infected area. However, one should ensure that the oil is pure and of good quality standards.

• As per research studies, Aloe Vera tends to lower the PH levels, thereby creating an inhabitable environment for C.Albicans. Aloe vera is also an excellent detoxifying agent and helps in the elimination of toxins, thus, reducing the strain on the immune system.

Even scientific evidence has claimed that consumption of Aloe vera juice strengthens the immune system by facilitating the production of Macrophages in the body. Macrophages are white blood cells that help fight various infections and harmful microbes including C.Albicans.

Thus, consuming Aloe vera juice or taking supplements is recommended to fight off a yeast infection. Topical application of pure Aloe vera gel to the yeast infected area, 2 to 3 times a day, can also prove to be beneficial.

• Clove is a powerful fungus fighting agent, containing anti-fungal elements such as Eugenol, Eugenol Acetate, Caryophyllene, and Iocaryophyllene. As per research studies, Clove essential oil is proven to kill certain yeast cells and its killing effect on C.Albican is at par to that of hospital-grade disinfectants (such as Povidone-Iodine and Chloroxylenol).

Clove oil can be directly applied to the yeast infected skin patch. For sensitive skin, it should be diluted with water or carrier oil prior to application.

The physician may recommend the following type of anti-fungal medicines:

• Topical anti-fungal drugs (in the form of cream, gels, lotions, powders or solutions) which can be directly applied to the affected area of the skin.
• Oral antifungal medicines (in the form of tablet, capsule or syrup) that can be swallowed
• Intra-venous anti-fungal medicines (that are injected into the veins) are administered in the hospital.

The local candida infection of the skin can be treated by the application of topical anti-fungal drugs upon prescription by the doctor. The commonly advised anti-fungal’s are Clotrimazole, Miconazole, Econazole, Fluconazole, Ketoconazole, Terbinafine, Oxiconazole, Nystatin, and Amphotericin. The anti-fungal medicines either destroy the fungal cells or prevent them from growing/reproducing. In severe cases of Candida infections that have affected the mucosal lining or spread inside the body (Invasive Candidiasis), oral or intra-venal anti-fungal treatments are to be opted.

References

1. https://www.mdpi.com/2076-2607/5/2/32
2. https://adc.bmj.com/content/67/9/1065
3. https://www.cell.com/trends/immunology/fulltext/S1471-4906(16)30029-1