Yeast Infection

By
Dr.Alaa Al-sahlany
Oct. 30, 2022
 Pityriasis versicolor
,Caused by malassaezia furfur and M. globosa
are part of the normal follicular flora

Present with multiple hyperpigmentd or

hypopigmented patches with fine(fluffy or
furfuraceous) scale. Demonstration of this
associated scale may require scratching or
stretching the skin surface
Furfuraceous (bran-like) Fluffy
:Decreased pigmentation may be secondary to

The inhibitory effects of dicarboxylic acids on

melanocytes (dicarboxylic acids result from
metabolism of surface lipids by the yeast) or

Decreased tanning, due to the ability of the

.fungus to filter sunlight(work as a sunscreen)
More common during the summer months
owing to high temperature and humidity

Usually asymptomatic
,Malassezia is lipophilic: therefore

seborrheic regions, in particular the upper trunk )1(

and shoulders, are the favored sites of involvement

.adolescents are frequently affected )2(

Malassezia is dimorphic i.e. grow both as a yeast

and hyphae
 Diagnosis
Dx: KOH examination of scale scraping which
shows “Spaghetti and meatballs” which are
hyphae and spores, respectively
 Spaghetti and meatballs

Dermatophyte hyphae
 Treatment
Topical treatment : selenium sulfide or
ketaocoazole shampoo applied daily for a week.
Others: Other imidazoles, zinc pyrithion, sulfur,
and benzyl peroxide

Systemic : itraconazole (200 mg/day) for a week,

fluconazole (300 mg) weekly for two weeks
Candidiasis(Candidosis or
Moniliasis)
C. albicans is a common inhabitant of the
gastrointestinal and genitourinary tracts, and
skin

C. albicans is an opportunistic organism. Under

the right conditions e.g. decreased immunity,
moisture and decreased competing flora, It can
cause lesions of the skin, nails, and mucous
membranes
:Predisposing factors

Diabetes mellitus
Xerostomia(saliva inhibit growth of candida)
Occlusion e.g. under adhesive plaster
Hyperhidrosis
Use of corticosteroids and broad- spectrum
antibiotics
Immunosuppression, including HIV infection
 Diagnosis
Microscopical KOH examination show budding
yeast and pseudohyphae in stratum corneum
and superficial mucosa

Biopsy and Histological exam

Sabouraud culture . It takes about 4 days to
grow colonies
Clinical types
 Oral candidiasis (Thrush)
The mucous membrane of the mouth may be
involved in healthy infant

In the newborn the infection may be acquired

from contact with the vaginal tract of the mother
 :Pseudomembranous Candidiasis (Thrush))1(
White-to-creamy plaques on any mucosal surface.
Removal with a dry gauze pad leaves an ery-
thematous mucosal surface. Can involve dorsum
of tongue, buccal mucosa, hard/soft palate,
.pharynx, esophagus

Erythematous (Atrophic) Candidiasis: )2(

Smooth, red, atrophic patches(atrophic papillae)
Hyperplastic candidiasis: white plaques that )3(
.cannot be wiped off

.It is often the first manifestation of AIDS

:Rx
Topical:oral nystatin suspension or clotrimazole
troches that dissolve in the mouth
.Systemic: fluconazole and itraconazole
 Angular Cheilitis(Perleche)

White plaques with slight erythema of the

mucous membrane at the angles of mouth.
Maceration and fissures may ensue

Is commonly related to C. albicans, but may be

caused by coagulase­positive S. aureus and Gram­
negative bacteria. Similar changes may
.nutritional deficiency e.g. riboflavin and iron
Drooling in persons with malocclusion caused by
ill­fitting denture or overlap of angles of mouth in
.edentulous elderly are predisposing factors

RX: Topical anticandidal

 Candidal vulvovaginitis
Overgrowth of candida can cause the labia to be
erythematous

There might be a pruritus, burning and curd-like

discharge

Pregnancy, OCP and tamoxifen treatment are a

predisposing factors
About 20% of asymptomatic women are vaginal
%carriers. During pregnancy, this rises to 40

Candidiasis can be sexually transmitted and this

is probably most important in recurrent
infections(more than 3 episodes per year)

Rx: vaginal suppositories containing nystatin or

imidazole. Single-dose oral fluconazole is an
alternative
 Balanitis and Balanoposthitis
Balanitis is more common in the uncircumcised
man

The skin is erythematous and glazed with

pustules and erosions

Rx: topical anticandidal agents or single dose

oral fluconazole. Treatment of sexual partner is
essential
 Candidal intertrigo
Can involve groins or armpits; intergluteal cleft;
under large breasts; under overhanging
.abdominal folds; or in the umbilicus

Red moist patches surrounded by a fringe of

.macerated epidermis (“collarette” scale)
Tiny pustules and papules are observed closely
adjacent to the patches, termed “satellite or
daughter” lesions

Rx: Topical anticandidal preparations are usually

effective. Oral anti-candidal agents are
alternative
 Diaper candidiasis
:Differentiated from contact dermatitis by

Involvement of the folds )1(

Occurrence of many small erythematous )2(
“satellite” or “daughter” lesions scattered along
the edges of the larger patch(es)

Rx: Topical anticandidal agents are effective.

Recurrent cases may be associated with gut
colonization and need Rx with oral nystatin
 Perianal candidiasis
May present as a pruritus ani

Pruritus and burning can be very severe

Characterized by erythema, maceration and less

commonly fissure

Rx: topical anticandidal agents are effective. Oral

antifungals are alternative
 Candidal paronychia
Redness, edema, and tenderness of the proximal
and lateral nail folds

Usually the fingers are affected more than toes

Patients commonly have an atopic background

Frequently seen in diabetics and those who work

:Two types
Acute: usually caused by staph. aureus

Chronic: multifactorial i.e. Irritant dermatitis and

candidiasis

Rx: Avoidance of chronic exposure to water and

irritants and bringing the diabetes under control
in addition to topical steroids in combination with
topical anti-candidal agents
 Chronic paronychia
Acute paronychia
 Erosio interdigitalis blastomycetica
Oval­shaped area of macerated white skin
associated with fissures and raw red skin at the
center on the web between fingers

Nearly always between the middle and ring

fingers

Moisture beneath the ring predispose to

infection
On the feet it is the fourth web space that is
most often involved

Clinically, this may be indistinguishable from

tinea pedis

Rx: drying and topical anticandidal agents

 Antifungals
Comment Spectrum of Antifungal agent
action
In general, the longest course Dermatophytes, Candida Imidazoles e.g. ketoconazole,
of treatment is for tinea and Pityrosporum itraconazole, fluconazole,
unguium followed by tinea :clotrimazole
capitis followed by other types
of dermatophytosis

Griseofulvin is the first choice Dermatophytes Allylamines e.g. terbinafin

for treatment of tinea capitis
(4-12 weeks course)
Candida only Polyenes e.g. amphotericin B
Imidazoles and allylamines are and nystatin
the first choice for treatment
of tinea unguium but
griseofulvin is not used for
tinea unguium because it
require a long course (4-6 Dermatophytes only Griseofulvin
months to one year)
 Antifungals
Comment Spectrum of Antifungal agent
action
Dermatophytes, Candida Imidazoles e.g. ketoconazole,
Griseofulvin is the first choice and Pityrosporum itraconazole, fluconazole,
for treatment of tinea capitis :clotrimazole
(4-12 weeks course)

Imidazoles and allylamines are

the first choice for treatment Dermatophytes Allylamines e.g. terbinafin
of tinea unguium

Candida only Polyenes e.g. amphotericin B

and nystatin

Dermatophytes only Griseofulvin

 Candidid(id reaction)
They are much less common than the reactions
.seen with dermatophytosis