Overview

Yeast infection is what we refer to when there is a fungal infection in the body and the most common kind of yeast infection is by the fungus Candida. There are over 100 different species of candida that have been identified. The fungus candida is even normally present on the skin and even in the oral cavity or intestinal tract under normal circumstances and this is what we call as a part of the normal microbiological flora. However, when the balance of the microbiological flora is disturbed and the organism count is increased significantly it results in symptoms due to the burdening of the infection.  

Sites of infection

The candida fungus can cause an infection on the skin or on the mucus surface or even in the internal organs.  As a dermatologist, the most common sites of infection with the yeast or on the skin folds where there is moisture and sweat accumulation like the groin fold, armpit or the finger and toe web spaces; and it is also commonly seen in the oral cavity on the buccal mucosa or the tongue and also on the mucous membrane of both male and female genitalia.  

Why do you get it

The fungus may cause an infection if it gets the opportunity to multiply which is often seen due to poor hygiene or exposure to hot and humid weather or due to usage of restrictive clothing with causes moisture accumulation on the skin surface. As the fungus is known to be present even under normal circumstances the growth of the organism may accelerate if there is a compromise in the immune system which may happen because of certain immunosuppressive topical or systemic medications; or it may also be seen due to coexistent immunosuppressive disorders. The yeast infection is also commonly seen in people who are overweight in which there is more constant moisture accumulation in the skin folds.  It is also commonly seen in people with diabetes if the sugar is not adequately controlled. Also, in some patients it may also be seen as an actor occupational hazard if their work environment involves their exposure to moisture for prolonged duration. 

 Signs indicating a Yeast Infection

1. Itching and irritation -  patient may experience itching or irritation on the skin in the presence of the infection.

2. Red rashes – patiently notice reddish rash along with a white there development on the surface in the area of the infection.

3. Body folds rashes- presence of such rashes between the finger spaces or the two spaces and other body folds like armpit, groin or waist is commonly seen.

4. Oral cavity patches -  thickened reddish whitish patches maybe seen over the tongue or over the bubccal mucosa inside the oral cavity.

5. Genital infection -  females may experience white discharge from the vagina area along with itching whereas males may experience white patches and red areas over the penis and also cuts over the foreskin tip.   

A patient experiencing these symptoms should seek the opinion of an expert dermatologist for proper diagnosis and assessment of the problem.  The pattern and distribution of the rash along with the presence of erythema or maceration will guide the dermatologist to come to a diagnosis.  Another key feature that is often seen is the presence of satellite lesions at the margins of the affected areas. 

Diagnosis 

A scraping from un affected area can be taken and assessed on a KOH mount which will show the presence of pseudohyphae under the microscope. Also a sample of the affected area can be sent for fungal culture along with the drug sensitivity if required.  This would be a confirmatory test for the assessment of the problem.  

Differential Diagnosis

In the body folds certain other conditions may also mimic the presentation like inverse psoriasis, gram negative infection or erythrasma,  jaquet’s irritant contant dermatitis.  

Treatment

The affected area should be kept dry and avoid excess moisture accumulation. Antifungal treatment would be needed to adequately control the infection and based on the extent and severity the choice and those of the systemic as well as topical antifungal would vary. The various systematic antifungals that have been used for used infection are amphotericin B , itraconazole,  ketoconazole.  Creams containing miconazole, sertaconazole, eberconazole, luliconazole, ketoconazole may be used for treatment. 

 -Dr Sujit Shanshanwal

MBBS, MD, ECFMG(USA)