How and Where Yeast Infection it Manifests Itself.

Skin, or Cutaneous Yeast Infection is the most common form of Candidiasis. It can present in many different areas, including the Skin-folds and webs of the fingers (Intertrigo), Nails (Onycomycosis, Paronychia), Ears (Otitis externa), Hair (Folliculitis), Penis (Balanitis), and Vagina (Vaginitis).

Skin Yeast Infection
Nail Yeast Infection
Ear Yeast Infection
Hair Yeast Infection

Skin folds (Intertrigo)

Intertrigo is inflammation of the skin caused by two skin surfaces rubbing together, creating friction. It is commonly found in areas where there are skin flaps, moisture, and little circulating air are present: the groin area, underneath the arms and breasts, neck creases, in between fingers, underneath large abdominal skin flaps in obese people, and the diaper area in infants. Diabetics, bed-ridden patients, and people who perspire a lot are also at risk.

Intertrigo can lead to secondary skin infections that can be caused by many organisms, the most common of which are bacterial or fungi. The most common fungi, Candida, can lead to a yeast infection in the area. Yeast Intertrigo is characterized primarily by mild redness that initially presents as red plaques, almost in a mirror image, on each side of the skinfold.

The redness may progress to more intense inflammation with erosions, oozing, fissures, exudation, maceration, and crusting. The lesions may have a distinct border, and are almost always associated with smaller satellite lesions. Patients may present with itching, burning, and pain in the affected areas.

Treatment

Treatment is usually geared toward minimizing moisture and friction.

• Talcum or cornstarch powder may be used to decrease moisture for mild cases of Yeast Intertrigo. If inflammation is predominent, a topical mild steroid may be used.
  
• It is helpful to lose weight if the person is obese.
  
• Wearing loose, breathable clothing of natural fiber like cotton is recommended.
  
• For those with a yeast infection, antifungal creams, ointments or pills may be used. Topical antifungals (e.g., Imidazoles, Allylamines, Ciclopirox [Loprox]) in ointments or creams are prescribed. Oral antifungals such as Fluconazole (Diflucan) or Itraconazole (Sporanoz) are given only if topical therapy is not effective.
  

Nails (Onychomycosis, Paronychia)

Fungal infection of the nails (Onychomycosis, pronounced "on-ee-ko-my-ko-sis") accounts for one third of fungal skin infections. Candida is one of the many types of fungi that can infect the nail. Toenail Onychomycosis caused by Candida usually occurs in people with immune deficiency who get chronic Mucocutaneous Candidias. The infected nail is thick, opaque, and loosened from the nail bed. It is usually painless.

Candida can also cause Paronychia (inflammation of the nail folds), especially in people whose habits or occupation involves frequent immersion of their hands in water, such as laundry workers, office cleaners, dishwashers and swimmers. It is painful, and causes redness, swelling, and pus. It can progress to yellowing of the nail with separation of the nail from the nail bed if it is not treated.

Treatment

Treatment involves limiting exposure to irritants and moisture and treating the underlying infection.

• Topical steroid and broad-spectrum topical antifungals such as Nystatin and triamcinolone cream are used for chronic Paronychia.
  
• Oral antifungals such as Itraconazole (Sporanox), and Terbinafine (Lamisil) may be used for Onychomycosis and Paronychia. For those that are nonresponsive, systemic antifungals are used.

Treatments for both disorders are slow and make take 9 to 12 weeks to see an improvement.

Ears (Otitis externa)

Otitis externa is a superficial infection of the skin in the ear canal. Cerumen (ear wax) protects the ear from debris, water, and organisms, but too much can cause retention of these substances in the ear, creating an infection. The skin can become macerated and inflamed, leading to a secondary infection with bacteria or rarely, fungi such as Candida.

An ear yeast infection can occur in swimmers or in hot in humid climates. Symptoms are tenderness of the outer ear, ear fullness or pressure, swollen lymph nodes, redness, itching, and discharge. A grayish membrane may be present in the canal.

Treatment

Mild cases of ear yeast infections are treated with topical acidifying and drying agents. Surgical debridement of the discharge is the mainstay of treatment for fungal infections.

Otitis externa usually resolves 7 to 10 days after treatment is started.

Hair (Folliculitis)

Candida is sometimes the cause of Folliculitis (or infection of the hair follicles). People who are susceptible to a yeast folliculitis are the inmmunocompromised (Cancer, HIV, etc.), Diabetics, IV drug abusers, or those on prolonged antibiotic or Corticosteroid therapy.

The infection is found predominantly in the hair follicles and rarely become extensive. The papular lesions are itchy, red, and may produce pus. It must be distinguished from Folliculitis caused by the Dermatophytes and Tinea Versicolor, because the treatments are different.

Treatment

Treatment includes topical antifungals such as Clotrimazole (Lotrimin, Mycelex) to control the infection. Local measures (saline compresses and topical antibacterials or antifungals such as Clotrimazole) are usually sufficient to control the infection.