Cutaneous manifestations of candidiasis.

Candida is identified microscopically by the observation of hyphae, linear chains of asexually budding yeast. Since these structures do not grow extensively through the stratum corneum, cutaneous samples may require Gram stain for identification. Since Candida can colonize normal tissue and also be a culture contaminant, clinicians should consider predisposing factors and clinical presentation when making a diagnosis of candidiasis. Predisposing cutaneous factors for candidiasis include occlusion, maceration, and altered barrier function. The hallmarks of Candida infection are bright erythema, fragile papulopustules, and satellite lesions. Cutaneous and mucous membrane candidiasis may differ in appearance, and sexual transmission should be considered. Treatment usually involves a topical or oral anticandidal agent, such as an imidazole. Although implicated as a predisposing factor to candidiasis, mild topical steroids can be used as short-term adjuvant treatment of these infections; when used responsibly, steroids provide antiinflammatory effects that speed relief of patient discomfort.