Candidiasis of the skin

Candidiasis is a fungal disease of the skin, mucous membranes and internal organs caused by fungi of the genus Candida.

Disease of skin candidiasis is most common in the tropics and subtropics.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

What causes candidiasis of the skin?

Fungi of the genus Candida are related to opportunistic microorganisms. They are widely distributed in the external environment, vegetate mainly in the soil of meadows, gardens and vegetable gardens, on the bark of fruit trees, as well as in fruits, vegetables and fruits.

As saprophytes, they are found on the skin, mucous membranes and in feces in 1/5 of the healthy people. The main causative agent is Candida albicans, less often Candida tropicalis, Candida pseudotropicalis, etc. The source of infection is a person with candidiasis (sexual contact, kiss, utensils, infection of the fetus when passing through infected birth canal). Infection is facilitated by exogenous factors (wet climate, maceration of the epidermis, manual processing of vegetables, fruits, berries in canning and confectionery production).

Pathogenetic factors include endocrinopathies, hypovitaminosis, immunodeficiency state, long-term use of cytostatics and broad-spectrum antibiotics, and others.

Histopathology of skin candidiasis

With superficial lesions of the skin, intercellular edema of the epidermis is noted, exocytosis with the presence of an agent in the thickened stratum corneum, in the dermis - a nonspecific inflammatory infiltrate. With granulomatous forms in the dermis, there are granulomas with giant cells of foreign bodies, microabscesses with neutrophilic granulocytes.

Symptoms of skin candidiasis

Clinically distinguish between superficial candidiasis of mucous membranes, skin, nails, chronic generalized granulomatous and visceral candidiasis.

Candidial stomatitis often develops in infants, but it can also occur in the elderly, weakened by chronic diseases. The disease of candidal stomatitis develops in weakened, tolerated or premature babies. The pathological process begins with hyperemia and swelling of the mucous membrane of the cheeks. Sky, gums, tongue, where there are pinpoint white raids in size from the point to the pinhead, resembling coagulated milk ("thrush"). Over time, the number and size of the foci increase, they merge and form films of different sizes. When they are removed, a pink, sometimes eroded, bleeding surface is visible. In adults (severe diseases leading to a weakening of the immune system), the disease usually begins after trauma to the mucous membrane, for example, dentures. After the stage of hyperemia and edema, a thick and coarse plaque appears, when erosion is observed, erosion is observed. With the defeat of the tongue (glossitis), a white filmy coating is observed not only on the back of the tongue, but also on the lateral surfaces, in the folds (furrows); the tongue is enlarged due to the edema, the filiform papillae are smoothed out.

In candidal tonsillitis on tonsils, in addition to the plaque, plugs are formed, but swallowing is painless, the body temperature does not increase, regional lymph nodes are not enlarged.

With acute and subacute candidiasis vulvovaginitis, hyperemia and edema of the mucous membrane, presence of white plaque, small erosions with scalloped outlines and detached epithelium along the periphery are noted. Observed whitish, crumbly, creamy or liquid discharge. Subjectively sick itch.

Candida balanoposthitis develops after sexual contact with a patient suffering from genital or anal candidiasis. Balanoposthitis is characterized by symptoms: the formation on the inner leaf of the foreskin and the head of the penis plaque white color, combined with superficial erosions; subjective patients are concerned about burning and pain. If the inner leaf of the prepuce and the coronary furrow are damaged, they become saturated red, swollen and moist.

For candidiasis cheilitis are the following symptoms: reddening of the red border of the lips, dryness, burning, tightening, grayish flaking scales.

The most commonly affected are large folds of the skin (under the mammary glands, inguinal, interannual). Clinically, the disease of candidiasis of the skin proceeds in the form of diaper rash. The boundaries of the lesion focus are clear, with a border of whitish macerated epidermis, a varnished, crimson-cyanotic color surface. Emerging erosions are clearly delineated from the surrounding skin and along their periphery there are fringes of exfoliated epidermis. Erosion and maceration of the epidermis are limited to the contacting surfaces of the folds. Around the foci of lesions, there are sometimes visible screenings in the form of small vesicles, pustules, or erythematous-squamous elements.

On the brushes the third interdigital fold is more often affected, which becomes red; The horny layer around it is swollen, whitish, with a pearly hue. The process often passes to the lateral surfaces of the main phalanges. This form of candidiasis is often found in women working in confectionery and food processing plants for fruit and vegetables. The course of the disease is chronic, with relapses; patients are concerned about itching and burning.

Similar lesions can be behind the auricles, around the navel, anal anus. On smooth skin candidiasis can occur in the form of erythematous, vesicular, psoriasiform sores.

The candidiasis paronychia often begins with the defeat of the nail roller. There is hyperemia and puffiness (puffiness) of the okolonoglovevoy roller, with a pressure from under it is a drop of pus. Over time, the paronychia passes into a chronic stage, the nail plate is affected, which becomes brown, bumpy, with bands and indentations, then becomes thinner, sometimes exfoliates. Candida paronychia and oiichia can be occupational diseases for confectioners, workers of fruit and berry canning enterprises.

Chronic generalized granulomatous candidiasis usually develops in persons with immune deficiency and endocrinopathies. The disease begins at an early age with candidiasis of the oral mucosa, glossitis, macrochill. Then develop the onychia and paronychia, the smooth skin of the trunk, extremities, the scalp in the form of pseudofurunculosis and decalting folliculitis is affected. Foci on the skin are hyperemic, infiltrated, with the presence of lamellar scaling, papules and tubercles. They are resolved by scarring and focal alopecia on the scalp. Such patients often have pneumonia, gastritis, hepatitis, epileptiform seizures, developmental lag.

Candidiasis of internal organs (respiratory tract, digestive tract, urogenital system, candidiasis of the central nervous system, candidosis, etc.) develops with prolonged antibiotic therapy.

Due to irrational irritating therapy, allergic rashes may occur in patients with candidiasis - levuridids in the form of erythematous-squamous, vesiculitis and other rashes accompanied by common phenomena (headache, malaise, etc.).

Differential diagnosis of skin candidiasis

The disease of candidiasis of the skin should be distinguished from tuberculosis, coccidioidosis, blastomycosis of the lungs, and other visceral mycoses.

[12], [13], [14], [15], [16], [17], [18], [19]

Treatment of candidiasis skin

It is necessary to simultaneously carry out symptomatic, pathogenetic and etiotropic treatment of skin candidiasis.

Of these etiotropic agents are appointed fluconazole (flunol, difluzol, diflucan, etc.), itraconazole, (tecnazol, orungal, etc.), lamil. With vaginal candidiasis, fluconazole is used once in a dose of 150 mg, with candidiasis of the skin - 50 mg daily for 2-4 weeks, with oropharyngeal candidiasis - 50 mg daily for 14 days. Intraconazole with candidiasis vulvovaginitis is prescribed 200 mg in 2 divided doses per day, with candidiasis of the skin - 100-200 mg per day (the duration of therapy depends on the prevalence of the process, in oral candidiasis - 100 mg once a day for 15 days. Vulvovaginal candidiasis is effective vaginal suppositories zalaina (enter intravaginally, once).

External apply 1-2% solution of iodine, furatsilin, brilliant greens, etc. The therapeutic effect increases with the appointment of antifungal drugs topical application (kanesten, travogen, lamizil, microspores, etc.).

It is necessary to eliminate concomitant diseases (diabetes, immune deficiency, etc.). Efficacy of treatment of skin candidiasis is increased by vitamins (A, C, group B) and fortifying agents.