Treatment of Recurrent Cutaneous Fungal Infections

Initial Treatment Strategy

Topical azoles, such as clotrimazole or miconazole, or nystatin are effective first-line treatments for candidal skin infections, especially in obese and diabetic patients, and it is critical to keep the infected area dry for treatment success, according to the Infectious Diseases Society of America 1

After controlling the acute episode, implement chronic suppressive therapy with fluconazole 100 mg three times weekly, which achieves symptom control in >90% of patients, as recommended by the Clinical Infectious Diseases society 2, 3
This regimen has a 40-50% recurrence rate after cessation of maintenance therapy, highlighting the importance of long-term management, based on evidence from the Clinical Infectious Diseases society 4, 5, 6, 7

Optimize glycemic control in diabetic patients to reduce the risk of recurrent infections, as advised by the American Diabetes Association 3
Initiate antiretroviral therapy in HIV-infected patients to reduce recurrence, according to the Centers for Disease Control and Prevention 2, 3, 8
For denture-related candidiasis, proper denture disinfection in addition to antifungal therapy is essential, as recommended by the American Dental Association 2, 3, 8

Treat for 7-14 days for most cutaneous candidal infections, and continue suppressive therapy for at least 6 months, as recommended by the Clinical Infectious Diseases society 2, 3, 4, 5, 6, 7, 8

Consider non-albicans Candida species, such as C. glabrata, in refractory cases, as these are less responsive to fluconazole, according to the Infectious Diseases Society of America 8
Failure to identify and address underlying causes, such as immunosuppression, diabetes, or poor hygiene, leads to treatment failure, highlighting the importance of comprehensive patient management, as advised by the Clinical Infectious Diseases society 3, 8