Cutaneo-mucous candidiasis is a mycosis, caused by a yeast called candida, which is part of the normal flora (saprophytic or commensal) of the digestive tract and the vaginal mucosa.

Candidiasis is due to the transformation of this saprophytic yeast into a pathogenic filamentous form which can adhere to the mucous membranes and invade them.

About ten species of candida are potentially pathogenic for humans, but it is candida albicans which is most frequently found.

Risk factors Candidiasis is an opportunistic infection, that is, it only develops under favorable conditions.

Some of the risk factors for candidiasis include: Diabetes This is the first contributing factor that the doctor will look for, especially in the event of a profuse or recurrent form of candidiasis.

Maceration In particular in the event of cutaneous involvement of the inguinal folds, intergluteal, interdigital ...

Antibiotic therapy Broad-spectrum antibiotics kill the natural flora of the mucous membranes, promoting the multiplication of candida.

Irritation of the mucous membrane Sexual intercourse, dry mouth are contributing traumatic factors

Immunosuppression By taking immunosuppressants, cortisone, AIDS ...

Symptoms of candidiasis In cutaneous forms Cutaneous candidiasis is manifested above all by intertrigos (redness) of the large folds (inguinal, abdominal, inframammary, axillary and intergluteal folds), and small folds (labial commissure, anus, interdigital spaces, rarely inter toe spaces).

The symptoms are the same: the redness begins at the bottom of the fold and then spreads back and forth to adjacent skin surfaces. The skin is red, varnished and oozing in appearance, cracked at the bottom of the fold which is sometimes covered with a whitish coating, the outlines are irregular, limited by a border in "desquamative collar", and the presence of small pustules in periphery are very evocative.

Sometimes the skin involvement is dry and flaky.

In the hands, the involvement often results from repeated contact with water, mechanical or chemical trauma, application of topical corticosteroids ...

The intertrigos of the large folds are related to the humidity, maceration or extension to the skin of digestive or genital mucosal candidiasis.

In nail forms Most often, it starts with perionyxis (redness and swelling of the skin around the nail), sometimes with pus leaking under pressure.

The nail is affected secondly, and it often takes on a greenish yellow, brown or black tint, especially in the lateral areas.

The attack often results from repeated contact with water, mechanical or chemical trauma, application of topical corticosteroids, repression of the cuticles, etc.

In mucous forms Oral candidiasis The most common manifestation is thrush or oral candidiasis. On a red mucosa

Small white areas appear like "curdled milk" more or less adherent on the inner face of the cheeks, gums, palate, pillars of the tonsils ...

Frequent in children, it can be seen in adults, especially in cases of immunosuppression.

Vaginal candidiasis It causes redness, itching and white discharge called "curdled".

It is estimated that 75% of women have had or will have one or more episodes of vaginal candidiasis. Among them, 10% suffer from a relapsing form defined by more than four episodes per year. It is not a sexually transmitted disease but an opportunistic infection that can be promoted by sexual intercourse due to trauma to the mucous membranes or exceptionally due to profuse balanitis of the partner. The phases of the cycle (preponderant role of the natural progesterone level) and pregnancy could also be beneficial.

Candidal balanitis The man has redness of the balanoproeputial groove sometimes covered with a whitish coating and dotted with small evocative pustules.

In men, genital candidiasis is often linked to repeated or chronic local irritations forming the bed of infection during intercourse with an infected partner, or to the existence of diabetes which should be investigated in principle.

In the event of candidiasis, stopping the contributing factors is always important to limit the risk of recurrence and to properly treat candidiasis.

Treatment of candidiasis of cutaneous forms On the hands, fight against repeated contact with water, mechanical or chemical trauma, the application of topical corticosteroids ...

The intertrigos of the large folds, limit humidity, maceration and check that there is no digestive or genital mucosal candidiasis likely to spread to the skin.

Whether it is an involvement of the large folds (inguinal folds, intergluteal folds, inframammary folds, abdominal or armpit folds) or an involvement of the small folds (interdigital or inter toe spaces, perlèche), the treatment should always associate:

the use of a mild soap type surgras or alkaline; a local antifungal treatment, lasting 2 to 4 weeks in lotion, solution, gel and powder, rather than creams and ointments that promote maceration. In infant diaper rash, mild and drying antiseptics are used most often based on copper and zinc; local antifungals are prescribed in the form of milk, gel, cream, lotion or emulsion.

Treatment of candidiasis of nail forms Fight against repeated contact with water, mechanical or chemical trauma, application of topical corticosteroids, cuticle pushback ...

The treatment combines:

very careful drying of the hands; finger baths for a few minutes with an antiseptic: Betadine® dermal solution, aqueous chlorhexidine (Plurexid®, Hibitane®, Hibidil®), Hexomédine® solution, in particular Transcutaneous Hexomédine®; the application of a local antifungal gel or lotion, in light massages on the periphery of the nail and the nail several times a day and, if possible, after each wash of the hands until healing, it is- that is to say until obtaining a normal nail (it takes 4 to 6 months in general). Treatment of oral candidiasis Fight against dry mouth (use of saliva substitutes), stop neuroleptics if possible ...

In immunocompetent adults The doctor often offers mouthwashes with Betadine® ENT, Eludril® or with a sodium bicarbonate solution and the disinfection of a possible dental prosthesis.

Amphotericin B (Fungizone®) in oral suspension or miconazole (Daktarin®) is often used, as an oral gel away from meals and drinks and kept in contact with the mucosa as long as possible (at least a few minutes) before to be swallowed for 1 to 3 weeks.

It is sometimes necessary to disinfect the digestive tract by the combined intake of Mycostatin®, Fungizone® or Daktarin® tablets.

In the event of associated angular cheilitis or anitis, an antifungal cream will be associated with the treatment of oral-digestive candidiasis on the skin: Mycostatin® ointment, Mycoster® cream, Lamisil® cream for 2 to 3 weeks.

In immunocompromised adults If oral candidiasis occurs in an immunocompromised area, treatment with tablets must be combined with local treatment and it is often necessary to carry out preventive treatments for recurrence, using drugs such as Nizoral®, Triflucan® or Sporanox®

In children and infants The products that can be used in babies with thrush are Mycostatin® oral suspension, Fungizone® suspension and Daktarin® oral gel

Treatment of vaginal candidiasis Fazol G®, Gyno-Daktarin®, Gyno-Pevaryl® and Monazol® eggs are used for 1 to 6 days, associated with a toilet with an alkaline soap (Hydralin®) or with bicarbonate water

The sexual partner (s) should be treated if they have candidal balanitis.

Treatment of candidal balanitis Fight against repeated or chronic local irritations and balancing diabetes if it exists.

We often recommend washing with Hydralin® soap, a surgras soap or with bicarbonate water and the application of a local antifungal twice a day for 15 days to 3 weeks.

Our doctor's opinion Relapses of candidiasis are a major and frequent problem. They are often due to the maintenance of contributing factors (unbalanced diabetes, maceration, immunosuppression, irritation of the mucous membranes, etc.). It is therefore often necessary to insist on the eradication of these contributing factors

In the event of numerous recurrences despite the eradication of the contributing factors, oral antifungals are sometimes prescribed on a regular basis, for example in vaginal candidiasis presenting more than 4 relapses per year, an antifungal ovum and / or a drug such as Triflucan ® for several months, targeting as best as possible the date of recurrence (generally around the 19th day of the cycle)