Cutaneous Candidiasis Workup

Updated: May 22, 2018
  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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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. [40]


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.

Of all the types of Candida, the electron microscope shows that C albicans is the most confluent in its adherence to the skin. [41]