Management of Intertriginous Candidiasis

Signs and Symptoms to Identify

Erythematous, moist, macerated skin in the inframammary fold with satellite pustules or papules at the periphery, often associated with pruritus and burning sensation, is a common presentation of intertriginous candidiasis in overweight or diabetic patients 1
Pruritus and burning sensation in the affected area, often worsening with heat and moisture, are characteristic symptoms of intertriginous candidiasis 1
White, curd-like discharge or scaling may be present on the skin surface, and foul odor can develop in chronic cases due to secondary bacterial colonization 1

The Infectious Diseases Society of America recommends applying topical clotrimazole, miconazole, or nystatin cream twice daily to the affected area for 2-4 weeks, while keeping the inframammary area dry and avoiding occlusive clothing 1

Oral fluconazole 100-200 mg daily for 7-14 days is appropriate for moderate-to-severe intertriginous candidiasis, particularly in diabetic patients, according to the Clinical Infectious Diseases guidelines 2, 3
For fluconazole-resistant C. glabrata, the Infectious Diseases Society of America recommends using amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days or oral flucytosine 25 mg/kg four times daily 2, 3

For fluconazole-refractory disease, the Clinical Infectious Diseases guidelines suggest using itraconazole solution 200 mg once daily or posaconazole suspension 400 mg twice daily for 3 days, then 400 mg daily for up to 28 days 2, 3, 4
Alternative options include voriconazole 200 mg twice daily or amphotericin B deoxycholate oral suspension 100 mg/mL four times daily 2, 3, 4

Clinical improvement should occur within 7-14 days of initiating appropriate therapy, and complete resolution is expected by 3-4 weeks after treatment completion, according to the Praxis Medical Insights guidelines 4
If symptoms persist beyond 14 days, fungal culture and susceptibility testing should be obtained to identify resistant species 4