Candidiasis

In macerated skin, C. albicans may invade to establish infection. In different body regions, distinct clinical features are found.

In the immunosuppressed or immunodeficient child, the tongue and lips may also be involved. Involvement of the angles of the lips is common (angular cheilitis). Candida can invade the skin folds, producing intertrigo or superinfect diaper dermatitis. The appearance of satellite red papules or pustules may be a useful clue. Paronychia with red painless swelling of the skin around a thumbnail or fingernail is a common result of thumb sucking.

Congenital candidiasis, which is quite rare, is acquired in utero and presents with red, scaling skin with scattered pustules at birth.

Vulvovaginal candidiasis presents as a thick white discharge with red mucosa. It is seen predominantly in teenage females.

Candidal granulomas are oval red plaques with a thick yellow crust seen on the head and neck of children with defective host defenses. They are accompanied by persistent thrush. Granulomas are quite rare.

Children with HIV infection, long-term glucocorticosteroid treatment, type 1 diabetes mellitus, cancer chemotherapy or oral contraceptive use are unusually susceptible to candidiasis.

For infantile thrush, nystatin oral suspension four times daily for 5 days is efficacious.

Older children with thrush and/or angular cheilitis the use of clotrimazole troches may be helpful. Many agents will clear cutaneous candidiasis including nystatin cream, oxiconazole, ketoconazole, econazole, micoazole or clotrimazole creams when applied four times a day for 3 to 5 days. If there are breaks in the skin the creams may sting. Nystatin ointment will not sting.

Oral therapy is reserved for children who are immunosuppressed, immune deficient, or have cancer. Oral fluconazole or itraconazole 5 mg/kg/day for 21 days is usual treatment. Vaginitis in the adolescent female may be treated with a single 250 mg dose of fluconazole.