Candidosis intertriginous B37.2

Erosive, macerative infection of the intertrigins (axillae, groin bends, overlapping skin folds; perianal region; submammary) by Candida albicans. Most frequent complication of an intertrigo.

In incontinence, diapers lead to maceratively erosive intertrigo at the contact points. Intertriginous candidiasis (candidiasis) is thus a primary irritative disease of multifactorial origin with secondary superinfection by bacteria and yeasts of the genus Candida.

V.a. Intertrigines (= Intertrigo candidamycetica), especially submammary, inguinal, axillary, umbilical area, perianal.

• Intertrigo: no evidence of yeasts
• Erythrasma: dry, non-macerative dermatitis; brownish-reddish hue.
• Pemphigus chronicus benignus familiaris: chronic, macerative, completely therapy-resistant dermatitis, evidence of the concertina phenomenon.
• Psoriasis intertriginosa: chronic, often macerative, completely therapy-resistant dermatitis. Mostly affecting the perional region; sharp demarcation.
• Allergic contact dermatitis: acute pruritic dermatitis; possibly weeping; typically satellite lesions.
• Toxic contact dermatitis: acute pruritic dermatitis; usually cause identifiable; possibly weeping; no satellite lesions.

Informing the patient about favourable factors. In adults, weight reduction!

In infants, use of breathable absorbent diapers. Diaper-free episodes.

Careful personal hygiene.

Mild cleansing measures (vegetable or paraffin-containing oils), dry the nappy area well or blow-dry.

• Brushing with aqueous antiseptic solutions such as quinolinol (e.g. quinosol 1:1000) or dye solutions such as aqueous eosin solution ( eosin disodium solution, ethanol-containing 0.5/1/2%, eosin disodium solution, aqueous 0.5/1/2%) or methylrosanilinium chloride solution.
• Alternatively, nystatin-containing pastes (e.g., nystatin-eosin disodium solution, ethanol-containing 0.5/1/2%dequalinium chloride cream, nystatin paste, Candio-Hermal soft paste, Mykundex). Intertriginous areas should be kept permanently dry (e.g. linen cloths, 100% cotton bras).

Reminder. Do not use strongly lipid-containing bases for intertriginous macerations as this leads to an occlusive effect without evaporation. Use aqueous solutions or pastes instead!

Candida dubliniensis also forms chlamydial spores on the rice agar. With the detection of chlamydospores, however, the diagnosis of Candida albicans is highly probable, as Candida dubliniensis is rarely found.

1. Halvaee S et al (2018) Investigation of Intertriginous Mycotic and Pseudomycotic (Erythrasma) Infections and Their Causative Agents with Emphasize on Clinical Presentations. Iran J Public Health 47:1406-1412.
2. Krajewska-Kulak E et al (2003) Difficulties in diagnosing and treating tinea in adults at the Department of Dermatology in Bialystok (Poland).Dermatol Nurs 15:527-530,
3. Seebacher C et al (2006) Candidosis of the skin. J Dtsch Dermatol Ges 4: 591-596