Yeast Infection By Dr.Alaa A. Naif Nov. 12, 2017

Pityriasis versicolor Caused by malassaezia furfur and M. globosa, are part of the normal follicular flora Present with multiple oval to round, hyperpigmentd or hypopigmented patches with fine(fluffy or furfuraceous) scale. Demonstration of this associated scale may require scratching or stretching the skin surface

Fluffy Furfuraceous (bran-like)

Decreased pigmentation may be secondary to the inhibitory effects of dicarboxylic acids on melanocytes (these 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,(1) seborrheic regions, in particular the upper trunk and shoulders, are the favored sites of involvement and (2) adolescents are frequently affected. Malassezia is dimorphic i.e. grow both as a yeast and hyphae 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 and ketoconazole.

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 Histological exam with PAS stain

Sabouraud culture , C. albicans should be differentiated from other forms of Candida that are only rarely pathogenic. It takes about 4 days to grow colonies

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

(1)Pseudomembranous Candidiasis (Thrush): 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. (2) Erythematous (Atrophic) Candidiasis: Smooth, red, atrophic patches(atrophic papillae)

(3) Hyperplastic candidiasis: white plaques that 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 Gram­negative bacteria. Similar changes may nutritional deficiency e.g. riboflavin and iron.

Drooling in persons with malocclusion caused by ill­ fitting 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, moist. There might be a pruritus, burning and curd-like discharge Pregnancy, high-dose estrogen and long­term tamoxifen treatment are a predisposing factors

About 20% of asymptomatic women are vaginal %carriers 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: (1) Involvement of the folds (2) Occurrence of many small erythematous “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 fingernails are affected more than toenails 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

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