![]() ![]() The azoles, allylamines, and polyenes represent the most widely used treatments for infection caused by dermatophytes and Candida. Signs include swelling, fissures, and a thick, white, curdy vaginal discharge. Women presenting with VVC will complain of sudden onset, intense vulval pruritus, external dysuria, and pain. 3 Of the infections caused by the Candida species, VVC can be treated with topical medications. 3 Infections caused by Candida are more likely than dermatophytes to be severe, and are more capable of causing invasive and systemic disease, especially in immunocompromised patients. 5Ĭandida infections of the skin typically occur in warm, moist areas of the body but can be difficult to distinguish from a dermatophyte infection, owing to a similar clinical appearance. 3,8 Deeper dermatophyte infections are uncommon because they do not typically survive at the body’s normal core temperature of 98.6☏, although spread to the internal organs, central nervous system, and bones has been reported. Inappropriate treatment of the infection, such as with steroids, can cause an alteration in the presentation of the infection and potentially lead to misdiagnosis. Lesions that are larger will display irregular margins and can be surrounded by smaller lesions. 1,3,4,7 Cutaneous infections may develop into papules or become larger and more inflamed, resulting in vesicopustules. Symptoms are dependent on the specific site of infection and range from scaling of the skin and patchy hair loss to scarring from inflammatory dermatologic conditions. Indirect transmission is common because dermatophytes can live for extended periods of time without a host. 3 Direct contact is the skin-to-skin transmission of the fungi from one individual or animal to another, whereas indirect contact is common through towels, clothing, and bathroom accessories and in communal bathing areas. 5 Transmission is possible via direct and indirect contact. Patients with impaired immune systems are susceptible to more severe, systemic fungal infections, as well as secondary bacterial infections. Immune function of the host, site of infection, and the specific fungal species influence the pathogenicity of the infection. 3,5 Clinical Presentation and Pathophysiology 2,6 Diabetes, genetics, and circulatory disorders, among others, impact the immune system and place the patient at higher risk for fungal infections. 2 Superficial candidal infections can also manifest following tissue damage to superficial layers of the skin in skin folds near the groin in intergluteal folds and between the fingers. Vulvovaginal candidiasis (VVC) is an infectious condition, predominately of Candida albicans (85%), with Candida glabrata or Candida tropicalis causing the remaining infections. In addition to dermatophytes, Candida species can also cause superficial infections that can be treated with topical medications. 4,5 However, there are multiple species of Trichophyton as well as Microsporum that are responsible for tinea infections. 1,3 Of the dermatophytes, Trichophyton rubrum has become the prevailing cause of infection in the United States and Europe, although various species predominate from one country to another. ![]() 5 Most infections are confined to the stratum corneum, nails, and follicles of the hair however, deeper infection is possible, especially when prudent treatment is not sought. 1,3,4 These fungi seed keratinized tissues, infecting the skin, hair, and nails. ![]() The majority of infectious dermatophytes belong to the genera Epidermophyton, Mirosporum, and Trichophyton. Identification of dermatophyte infections is categorized based upon the anatomical site of infection through Latin terminology such as capitis (head) corporis (body) and pedis (foot). While generally thought of as an outpatient condition, many patients who present to the hospital have concomitant fungal infections that if left untreated or treated inappropriately, can become severe and complicate the overall management of hospitalized patients. 1 They represent a persistent problem across healthcare settings owing to various fungal pathogens and sites of infection. A variety of topical treatments are available, including allylamines, azoles, and polyenes.įungal infections of the epidermis are common worldwide and are estimated to affect 10% to 20% of the world’s population. As the severity of the condition increases, the patient can become more susceptible to other infections. Improper treatment can lead to disease progression. While unlikely to be the cause of a patient’s hospital visit, the infection should address be addressed by healthcare providers either by initiating treatment or continuing it as outpatient therapy. ABSTRACT: The prevalence of dermatophytes and topical candidal infections is high worldwide.
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