General Medical Information

Candidiasis and Fungal Infections

Wilberto Nieves-Neira
Bhagirath Majmudar
Ira R. Horowitz

Candidiasis is frequent in children but much less than in adults. Contrary to adults, it is most frequently a vulvar disease rather than a vulvovaginitis. Candida grow well in the estrogenized mucosa of adults that has a higher content of glycogen. Up to 25% of girls with vulvovaginitis grow C. albicans in cultures. Candida vulvitis presents as a spectrum of severity, from mild erythema and edema with pruritus to an intense red, macerated, eczematoid dermatitis with pustules. Chronic candidiasis presents with thickened, reddish-brown skin and areas of excoriation. Underlying skin disorders, such as atrophy and atopic and seborrheic dermatitis, are likely to present initially as Candida infection. Secondary infection with Candida is common in diaper rash, which is a contact dermatitis. Antecedent use of antibiotics or diabetes mellitus is more common than in adults. Recurrent Candida infections occur in immunocompromised children. Diagnosis can be established by visualization of pseudohyphae in a saline or potassium hydroxide wet smear or by cultures. Treatment involves decreasing the inflammation with local measures such as sitz baths for a day or two. Antifungal agents such as miconazole or clotrimazole creams then are applied for 1 week. In the case of seborrheic dermatitis with secondary candidiasis, hydrocortisone cream can be applied and allowed to dry, followed by nystatin powder.

Pityriasis versicolor is rare before puberty and in the genital area. The Pityrosporum orbiculare has been reported in the genital area in Afro-Caribbeans. Skin scrapings show the mycelia and spora. Topical agents such as clotrimazole are effective treatment.