FFinalistSouthampton · 2027
Dermatology
AKT · Dermatology/Infections & infestations

Cutaneous candidiasis

Candida albicans — warm moist flexural overgrowth

Overview

Candida albicans overgrowth in warm, moist flexures (intertrigo) — submammary, groin, axillae, abdominal folds, and between digits. Beefy-red plaques with characteristic SATELLITE papules/pustules, often with predisposing diabetes, obesity, occlusion or antibiotics.

Recognise

  • Beefy-red, moist, macerated plaques in body folds with a scaly edge
  • Satellite papules and pustules beyond the main plaque — the discriminating sign from tinea
  • Risk factors: diabetes, obesity, occlusion/moisture, broad-spectrum antibiotics, immunosuppression; in groin it INVOLVES the scrotum (tinea cruris spares it)

Red flags

  • Recurrent/extensive candidiasis → screen for diabetes or immunosuppression

Differentials & how to tell them apart

Tinea crurisadvancing scaly edge with central clearing, SPARES the scrotum, no satellite lesions
Inverse psoriasiswell-demarcated smooth red flexural plaques, no satellites, psoriasis elsewhere
Seborrhoeic dermatitisgreasy scale, scalp/face distribution
Erythrasmabrown flexural patches, coral-red fluorescence on Wood lamp (Corynebacterium)

Clinical image

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Cutaneous candidiasis — clinical imagesDermNet

Investigations

Clinical; skin swab or scraping for microscopy/culture if uncertain. Check blood glucose if recurrent.

Management

Topical imidazole (clotrimazole) + keep the area dry and address risk factors

  1. 1Topical imidazole (clotrimazole/miconazole) + moisture-reduction measures (dry the folds, loose clothing, treat incontinence); add mild hydrocortisone if very inflamed.Gate: Satellite pustules and scrotal involvement point to CANDIDA, not tinea — and recurrent/widespread candidiasis should trigger a search for undiagnosed DIABETES or immunosuppression
  2. 2Extensive/resistant → oral fluconazole; optimise glycaemic control and weight; barrier measures to prevent recurrence.
Topical imidazole (clotrimazole) — first-line for cutaneous candidiasis
Topical imidazole + mild hydrocortisone — if marked inflammation
Oral fluconazole — extensive or resistant disease
Keep the area dry; treat predisposing factors — moisture reduction is essential

Key points

The satellite lesions and scrotal involvement separate candida from tinea cruris. Recurrent candida is a diabetes flag.

Monitor & prognosis

Resolution; glucose if recurrent.

Resolves with antifungals + moisture control; recurs if risk factors persist.

Source: NICE CKS Candida - skin; DermNet