What it looks like and where it occurs
The lesion begins with redness and weeping deep in the fold where the skin meets the skin. The surface becomes bright red, shiny, sometimes with a whitish coating and a crack along the bottom of the fold. A characteristic sign is small bubbles and spots along the periphery, the so-called screenings, which are not present in normal diaper rash. Patients complain of itching, burning and pain when moving. In infants, lesions under the diaper also affect convex areas of the skin, and not just folds, and are accompanied by lesions on the abdomen and thighs.
- Folds under the mammary glands, inguinal and axillary
- Abdominal folds with excess weight
- Interdigital spaces on the hands of people with wet work
- Corners of the mouth - candidiasis
- Nail area
- Diaper area in babies
Causes and risk factors
Candida becomes aggressive when the skin's protective barrier is compromised or local and general immunity is reduced. The main background factor in adults is diabetes mellitus: high glucose levels create a nutritious environment and impair the functioning of immune cells, so persistent candidiasis of the folds is often the first reason to suspect diabetes. Excess weight, profuse sweating, hot climate, tight synthetic clothing, and working with water have an effect. Taking antibiotics suppresses normal microflora, and systemic hormones and immunosuppression reduce protection.
- Diabetes and obesity
- Increased sweating and heat
- Broad spectrum antibiotic courses
- Systemic glucocorticoids and immunosuppressants
- Wet work, rubber gloves
- Rare diaper changes for children
- HIV infection and other immunodeficiencies
How is it different from other fold diseases?
Several similar states occur in the folds, and visually they partially overlap. Simple diaper rash occurs from friction and moisture, the skin turns red evenly, but there are no screenings along the edges. Erythrasma produces brownish-red spots with clear boundaries and almost does not itch. Dermatophytosis inguinalis forms ring-shaped lesions with a raised edge and is more common in men. Inverse psoriasis produces smooth, well-defined red plaques and does not respond to antifungal medications. Therefore, if treatment is ineffective, a revision of the diagnosis is necessary.
- Diaper rash from friction - no screenings
- Erythrasma - brownish spots, glow under a Wood's lamp
- Inguinal dermatophytosis is a ring-shaped lesion with an active edge
- Inverse psoriasis - clear red plaques
- Seborrheic dermatitis
- Contact dermatitis from cosmetics and linen
Diagnostics
Often the diagnosis is made clinically, based on the characteristic appearance of the lesion. To confirm, a scraping is taken from the affected skin and microscopy is performed; if necessary, culture is performed to determine the type of fungus and sensitivity to drugs; this is especially important for relapses and ineffectiveness of standard treatment. A mandatory part of the examination is to search for underlying causes. An adult with candidiasis of the folds is checked for blood glucose and glycated hemoglobin, and a complete blood count is assessed. If the course is widespread or persistent, the doctor discusses further examination of the immune status.
- Examination by a dermatologist, if necessary, Wood's lamp
- Microscopy of skin scraping
- Mushroom culture with sensitivity determination
- Blood glucose and glycated hemoglobin
- General blood test
- Examination for immunodeficiency in persistent cases
Treatment and prevention
The basis of treatment is external antifungal agents in the form of a cream, solution or powder, which are applied to the lesion and a little around it in a course prescribed by the doctor, and continued for several days after the rash disappears. Care is no less important: folds need to be washed and dried thoroughly, provide access to air, use cotton underwear and change it more often in hot weather. Wet areas are dried. For widespread lesions, nail involvement, or recurrences, your doctor may prescribe a systemic antifungal drug. Be sure to treat the underlying condition: compensate for diabetes, reduce weight. Hormonal ointments cannot be used without a prescription for fungal infections - they worsen the course.
- External antifungal agents in a course as prescribed by a doctor
- Thorough drying of folds after washing
- Loose cotton underwear, changed frequently in hot weather
- Systemic therapy for common forms
- Compensation for diabetes mellitus, weight loss
- Frequent diaper changes and air baths for children
- Refusal to self-use hormonal ointments