Introduction
The skin of the human body forms a complex ecosystem for multiple flora, including bacteria, viruses, fungi, and archaea. Several fungal species have been reported to be skin commensals, including Malassezia, Debaromyces, Cryptococcus, and Candida, in some sites. Candida species are not a part of the regular flora of the skin, but they reside on the skin and the mucosal surfaces, including the oral cavity, genitourinary tract, and gastrointestinal tract. Among the species of Candida, Candida albicans is most commonly involved in skin diseases.
What Is Cutaneous Candida?
Cutaneous Candida denotes a fungal infection of the skin caused by Candida species. Candida is a type of fungus that causes potentially harmful diseases. A cutaneous (skin) infection occurs due to the overgrowth of Candida species that resides as a commensal on the human skin. The skin infection caused by the species of Candida is referred to as cutaneous candidiasis or candidiasis of the skin. Cutaneous candidiasis involves superficial infections of the skin and mucous membranes of the body. It includes diaper dermatitis, perianal dermatitis, candidal balanitis, intertrigo, and erosio interdigitalis blastomycetica. Candidal infections of the skin are more prevalent in immunocompromised patients.
What Causes Cutaneous Candida?
Cutaneous candidiasis develops when the Candida species converts from a commensal to a pathogen due to various host factors, causing infection of the skin. Cutaneous candidiasis develops due to the Candida infection on the skin. Candida species may reside on the skin, but infection occurs when the Candida overgrows and begins to develop uncontrollably. It can be due to poor hygiene, warm weather, tight clothing, wet undergarments, use of antibiotics that disrupt the bacteria controlling the growth of Candida species, a weak immune system, pregnancy, and damp skin.
Host factors can also predispose an individual to cutaneous candidiasis. It includes nutritional deficiencies, local factors, endocrine diseases, and systemic immunodeficiency. Local factors such as ulcerations on the skin, skin maceration, trauma, xerostomia, and radiation-induced mucositis can also contribute to cutaneous candidiasis.
Nutritional deficiencies alter the defense mechanism in the body, allowing the adherence or penetration of the Candida species. Deficiencies of vitamins B and C, folic acid, and iron deficiency anemias can increase the risk of cutaneous candidiasis.
Endocrine disorders such as hypoparathyroidism, diabetes mellitus, hypothyroidism, Cushing’s disease, and polyendocrinopathy are also involved in increasing the susceptibility to Candida infection of the skin.
How Does Cutaneous Candida Develop?
Candida is a commensal fungus that resides in various sites of the human body. Cutaneous Candida is an opportunistic infection that arises from Candida species that selectively colonize gastrointestinal, oral, vaginal, and cutaneous epithelium. The ability of Candida albicans to grow into different morphological forms, such as pseudohyphae, unicellular budding yeast, and true hyphae, enables it to become more virulent and helps invade the host tissues. Factors such as variations in the skin environment, alterations in the immune system, antibiotic therapy, and underlying diseases can influence C. albicans to convert from a commensal to a pathogen, causing skin infections in susceptible individuals.
Under various conditions, Candida may undergo a mycelial transformation, invade the epithelial tissues, and stimulate a complement-dependent neutrophil-mediated acute inflammatory response leading to the formation of subcorneal pustules. This mechanism involves prerequisite colonization of candida species on the epithelial surfaces. The ability of the Candida species to adhere to the underlying epithelium is significant in tissue penetration after the production of hyphae. Initial events involve the adherence of candida species to the epithelial cell surface, proliferation, colonization, and invasion of the host tissues.
What Are the Symptoms Associated With Cutaneous Candida?
Cutaneous Candida involves the following symptoms:
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Red, growing skin rash.
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Intense itching.
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Cracks and soreness of the skin.
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Blisters and pustules.
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Rashes on the skin folds, buttocks, genitals, groin, armpits, between the fingers, under the breasts, and other areas of the body.
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Hair follicle infections.
What Are the Clinical Presentations of Cutaneous Candida?
Cutaneous Candida presents with the following symptoms based on the skin site involved;
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Candidal Vulvovaginitis:
Candidal vulvovaginitis refers to the candidal infection of the vaginal mucosa. The vaginal mucosa and vulvar skin show the presence of erythema (redness) with curdy white flecks within the vaginal discharge. The redness may spread to involve the perineum (the skin between the genitals and the anus) and groin, with the formation of satellite pustules. The vaginal mucosa also appears red and glazed.
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Candidal Balanitis:
Candidal balanitis refers to the candidal infection of the glans penis. It causes tiny papules, vesicles, pustules, or persistent ulcerations.
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Congenital Candidiasis:
Congenital cutaneous candidiasis manifests as an erythematous eruption of papules, macules, and superficial pustules on the trunk and extremities. These erythematous eruptions resolve with extensive desquamation.
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Candidal Diaper Dermatitis:
Candidal diaper dermatitis initially starts in the perianal area and spreads to involve the perineum, the upper thighs, the lower back, and the lower abdomen. The scaly papules merge to form eroded lesions.
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Oral Candidiasis:
Oral candidiasis involves the buccal epithelium, the palate, and the gums, with the involvement of the pharynx, tongue, or esophagus in severe cases. These lesions show an erythematous base when the lesions are scraped.
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Intertrigo:
Intertrigo presents with intense bright pink, pruritic, macerated rashes with papules and pustules. Erosio interdigitalis shows the presence of macerations between the third and fourth fingers.
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Candidal Paronychia:
The nail fold becomes erythematous and swollen with nail dystrophy and the loss of the cuticle, which may result in abscess formation secondary to bacterial infection.
What Are the Complications Associated With Cutaneous Candida?
Cutaneous candida includes the following complications:
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Cutaneous candida may result in widespread candidiasis in individuals with weakened immune systems.
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Cutaneous candida may cause recurrence.
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Candida of the nails may cause nail disfigurement.
How Is Cutaneous Candida Diagnosed?
The diagnosis depends on the clinical examination of the skin lesions. During the examination, the appearance of the skin and the location of the lesions helps diagnose Cutaneous candida. Also, the lesion is scraped off and sent to the laboratory to examine the presence of Candida species.
How Is Cutaneous Candida Treated?
Good health and personal hygiene are essential for the treatment of Cutaneous candida. It is important to keep the skin dry. Drying powders help prevent candida infections. Antifungal creams, ointments, and powders are prescribed to treat fungal infections of the skin, mouth, and vagina. Systemic antifungal medications are prescribed for severe fungal infections of the throat, mouth, and vagina.
Conclusion
Cutaneous candida represents a fungal skin infection. Candida species is one of the potentially harmful organisms that cause various skin disorders. Skin disorders may range from mild clinical manifestations to life-threatening diseases. Candida infections of the skin may be influenced by chemical, physical, local factors or individual immunodeficiencies. Under these circumstances, these commensals cause various skin infections. Early diagnosis and treatment are essential to manage this skin disorder.
