Management of Axillary Fungal Infections

Diagnosis

• Candida species are the predominant cause of intertriginous infections, presenting with erythema, pruritus, and swelling in skin‑fold areas. The Lancet Infectious Diseases (2025) 1
• Direct microscopy and culture remain the gold‑standard diagnostic methods for identifying the specific fungal pathogen. The Lancet Infectious Diseases (2025) 1

Indications for Systemic Antifungal Therapy

• Systemic therapy is recommended when axillary infection is extensive, bilateral, or fails to improve after ≥ 2 weeks of appropriate topical treatment. Clinical Infectious Diseases (2016) [2][3]
• Immunocompromised hosts (e.g., HIV infection, uncontrolled diabetes, patients receiving immunosuppressive drugs) require systemic antifungal treatment to achieve cure and prevent dissemination. The Lancet Infectious Diseases (2025) 1; Clinical Infectious Diseases (2016) 2

First‑Line Systemic Regimen

• Fluconazole 100–200 mg orally once daily for 2–4 weeks is the preferred oral agent for extensive cutaneous candidiasis of the axilla. Clinical Infectious Diseases (2016) [2][3]

Management of Refractory Infections (Failure of Fluconazole)

• Itraconazole oral solution 200 mg daily for up to 28 days can be used when fluconazole fails. Clinical Infectious Diseases (2016) [2][3]
• Posaconazole suspension 400 mg twice daily for 3 days, then 400 mg daily to complete a 28‑day course, is an alternative for refractory disease. Clinical Infectious Diseases (2016) [2][3]
• Voriconazole 200 mg orally twice daily for 2–4 weeks is another option for fluconazole‑refractory axillary infection. Clinical Infectious Diseases (2016) [2][3]

Special Populations

• Patients living with HIV should have antiretroviral therapy initiated or optimized to lower the risk of recurrent axillary candidiasis. Clinical Infectious Diseases (2016) [2][3]
• Strict glycemic control in patients with diabetes is essential to prevent recurrence of axillary fungal infections. The Lancet Infectious Diseases (2025) 1
• Individuals receiving IL‑17 inhibitors have an increased risk of candidiasis; prophylactic antifungal strategies should be considered in those with recurrent episodes. The Lancet Infectious Diseases (2025) 1

Assessment of Predisposing Factors

• Clinicians should actively investigate underlying predisposing conditions such as diabetes, immunosuppression, and occupational or environmental exposures that may contribute to axillary fungal infection. The Lancet Infectious Diseases (2025) 1