Cutaneous Candidiasis Workup

  • Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: William D James, MD   more...
 
Updated: Aug 2, 2011
 

Laboratory Studies

  • KOH preparation is the easiest and most cost-effective method for diagnosing cutaneous congenital candidiasis, but its use is not sufficient in the absence of other supporting clinical evidence.
  • Culture from an intact pustule, skin biopsy tissue, or desquamated skin can help to support the diagnosis.
  • Microscopic examination of skin scrapings prepared with calcofluor white stain is a simple way of detecting yeasts and pseudohyphae of Candida albicans. C albicans binds nonspecifically to polysaccharides found in fungal cell walls and produces a distinct bright color in a pattern characteristic for the organism when viewed under a fluorescence microscope.
  • When a greenish hyponychial fluid accumulates, material may be obtained by heating a pin and painlessly puncturing the intact overlying nail. The fluid release provides symptomatic relief to the patient, and fluid may demonstrate multiple yeast organisms when viewed using KOH preparation.
  • Lim and Lim report on a new contrast stain, trypan blue, for rapid diagnosis of candidal dermatomycoses.[25]
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Histologic Findings

A skin biopsy specimen stained with a periodic acid-Schiff stain reveals nonseptated hyphae. The presence of nonseptated hyphae allows cutaneous candidiasis to be distinguished from tinea.

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Contributor Information and Disclosures
Author

Noah S Scheinfeld, MD, JD, FAAD  Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Matthew C Lambiase, DO  Dermatologist, Skin Cancer and Dermatology Institute, Reno, NV

Disclosure: Nothing to disclose.

Daniel S Lehman, MD  Fellow in Minimally Invasive Urology/Oncology, Department of Urology, Columbia University Medical Center

Disclosure: Nothing to disclose.

Jessica M Allan, MD  Consulting Staff, Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Thomas Vaughan, MD, to the development and writing of this article.

References

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A moist, erosive, pruritic patch of the perianal skin and perineum (with satellite pustule formation) is demonstrated in this woman with extensive candidosis.
Discrete superficial pustules developed within hours of birth on the hand of an otherwise healthy newborn. A potassium hydroxide preparation revealed spores and pseudomycelium, and culture demonstrated the presence of Candida albicans.
Dry, red, superficially scaly, pruritic macules and patches on the penis represent candidal balanitis.
White plaques are present on the buccal mucosa and the undersurface of the tongue and represent thrush. When wiped off, the plaques leave red erosive areas.
Erythema, maceration, and satellite pustules in the axilla, accompanied by soreness and pruritus result in a form of intertrigo.
A nailfold with candidal infection becomes erythematous, swollen, and tender with an occasional discharge
Soreness and cracks at the lateral angles of the mouth (angular cheilitis) is a frequent expression of candidosis in elderly individuals.
Fine superficial pustules on an erythematous patchy base are suggestive of candidosis.
Candida infection should be in the differential diagnosis when one or more nails become discolored, has subungual discoloration, nailplate separation from the nailbed, and lack evidence of a dermatophyte.
Candidiasis. Courtesy of Hon Pak, MD.
 
 
 
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