Candida dermatitis

To maintain intact skin during the establishment of the program, a basic barrier wash of oleic acid, soybean oil, and potassium hydroxide followed by a moisture barrier cream of dimethicone 3% and glycerin stearate should be used. Candida dermatitis should be treated with an antifungal product and a cortisone cream for at least 14 days. Severe dermatitis or skin breakdown on the penis may require the replacement of an indwelling catheter until healed. Urethral ulceration and labia inflammation or polyps from catheter pressure can be treated with anti-inflammatory cream twice a day, for seven days, and then tapered slowly to twice a week as a maintenance program. 

Nystatin is mainly used to treat vaginal and oral infections and localized skin lesions, including Candida intertrigo and Candida nappy dermatitis. It may also be used as prophylaxis during treatment with antibiotics. 

Undecylenic acid, like zinc undecylenate, is very effective as an external drag for treating moderate dermatophyte infections and yeast dermatitis, but it is not effective for shingles and for Candida infections. Synonyms of this drug are benzevrine, micocid, undetin, and others. 

Topical azole derivatives include the imidazoles bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, lanoconazole, flutrima-zole and sertaconazole. These drugs show activity against the dermatophytes Epidermophyton, Mi-crosporum and Trichophyton. They are also effective against the yeasts Candida albicans and Pityrospo-rum orbiculare. Local side effects include pruritus, erythema and local irritation. Allergic dermatitis is rare. 

Biotin deficiency and the functional deficiency associated with lack of holo-carboxylase synthetase (Section 11.2.2.1), or biotinidase (Section 11.2.3.1), causes alopecia (hair loss) and a scaly erythematous dermatitis, especially around the body orifices. The dermatitis is similar to that seen in zinc and essential fatty acid deficiency and is commonly associated with Candida albicans infection. Histology of the skin shows an absence of sebaceous glands and atrophy of the hair follicles. The dermatitis is because of impaired metabolism of polyunsaturated fatty acids as a result of low activity of acetyl CoA carboxylase (Section 11.2.1.1). In biotin-deficient experimental animals, provision of supplements of long-chain 6 polyunsaturated fatty acids prevents the development of skin lesions (Mock et al., 1988a, 1988b Mock, 1991). 

Rarely, phlyctenulosis has been associated with pneumococci, Koch-Weeks, Candida albicans, Chlamydia, viruses, roimdworm nematodes, rosacea dermatitis, and meibomianitis. Malnutrition, vitamin deficiency, and poor public health conditions increase the incidence of phlyctenulosis. 

Isoconazole is mainly used for vaginal infections with Candida albicans. Contact dermatitis has been reported (14), including an unusual case with a papulo-pustular reaction (15). 

Candida albicans can be isolated in the majority of cases of chronic paronychia. The yeast has traditionally been considered to play an etiological role in the condition, but bacteria and irritant or allergic contact dermatitis also play a role, although the contribution of each varies from patient to patient. A more recent proposal is the primary role of repeated contact with various kinds of foods. Proteins of foods could induce a protein contact dermatitis (Tosti et al. 1992) and, secondarily, an infection by Candida albicans. The primary role of the yeast is, therefore, minimised. Professions at risk, apart from those already quoted as prone to develop Candida intertrigo of the interdigital folds, include all categories... 

Candida paronychia is often difficult to treat. Topical treatment is insufficient the best therapeutic approach is intermittent (pulsed) itraconazole or fluconazole, following the schedules indicated in the treatment of dermatophyte onychomycosis. Prevention of candidosis is straightforward. It includes the avoidance of maceration at work. Chronic paronychia is best prevented by the use of appropriate gloves. The avoidance of contact with foods incriminated in the initiating protein contact dermatitis (assessed by positive prick tests) is mandatory. 

---