Yeast Infection Skin Rash

Picture of Baby Yeast Infections

Candidiasis is by far the most common type of yeast infection in human skin. Candidiasis is infection with Candida species. More than 20 species of Candida exist. The most common is Candida albicans. These fungi live on all surfaces of our bodies and only occasionally cause infection. Various types of Candida yeast infections are possible, including the following:

• Perlèche (also termed angular cheilitis) is a softening of the skin with deep creases around the angles of the mouth.
• Thrush is a candidal infection of the mouth and throat. White patches appear in the mouth. Thrush occurs most commonly in the mouths of people with chronic diseases, including diabetes, HIV/AIDS, and cancer, and those who use systemic corticosteroids or other medications that can suppress the immune system.
• Intertrigo is an irritation of the folds of the skin. Candidal infections commonly occur in warm, moist body areas, such as the underarms, in the groin, under the breasts, between the legs, and under the folds of the skin of the abdomen of people who are obese. Any breakdown, cuts, or cracks in the skin may allow this organism to penetrate.
• Candidal rash affects the diaper area (diaper rash). It is caused by candidal infection that is allowed to penetrate the skin due to moisture.
• Candidal body rash can result from excess sweating, antibiotic use, or lack of movement leading to skin occlusion (for example, when a medication is applied to the skin and covered). It most commonly occurs in people with diabetes who are in the hospital.
• Candidal vulvovaginitis is a candidal infection of the vaginal tract. Candida albicans fungus is a common inhabitant of the vaginal tract and can result in itching, redness, irritation, soreness, and burning. This is often referred to as a feminine yeast infection.
• Congenital cutaneous candidiasis results from infection of an infant during passage through the birth canal. The rash appears within a few hours of delivery.
• Candidal paronychia is a chronic inflammation of the nail fold of your hand or foot. In some cases, it causes a discharge with pus, and a soft, watery swelling of the area around the fingernail or toenail.
• Erosio interdigitalis blastomycetica is a candidal infection between the finger webs. Skin softening and redness occur. Moisture trapped by rings is thought to cause the condition. Risk factors include people with diabetes and those who work with water (for example, house workers, launderers, and those exposed to strong chemicals).
• Chronic mucocutaneous candidiasis is a condition that results from a genetic defect that leaves those who have it with thick, horny skin lesions and with nail abnormalities.
• Systemic candidiasis is candidal infection throughout the body. This condition is rare. In systemic candidal disease, up to 75% of people may die. Even common mouth and vaginal yeast infections can cause critical illness, other health complications, and can be more resistant to normal treatment. This rash can manifest with bruises that can be felt. The bruises result from a reaction and response to Candida in blood vessels. Systemic yeast infections that return may be a sign of more serious diseases such as diabetes, leukemia, or AIDS.
• Candida can also affect the digestive system and may be associated with ulcers and inflammatory bowel disease (IBD), but Candida colonization in the digestive tract is not usually associated with a yeast infection skin rash.
• Ringworm is not the same as a yeast infection. Ringworm is another type of fungal infection caused by a type of fungus called a dermatophyte and can result in athlete's foot, jock itch, scalp infections, and infections of the nails and in skin folds.

An overgrowth of the fungus Candida is what causes yeast infections. Candidal infections commonly occur in warm, moist body areas, such as the underarms or where skin folds over itself like breast/chest skin. Usually, the skin effectively blocks yeast, but any skin breakdown or cuts in the skin may allow this organism to penetrate and infect.

• Areas typically affected by the fungus in babies include the mouth and diaper areas. Moist diapers can lead to an overgrowth of yeast.
• In adults, oral yeast infections become more common with increased age. Adults can also have yeast infections around dentures, in the folds under the breast and lower abdomen, in the nail beds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment.
• In women, vaginal yeast infections are the second most common reason for vaginal burning, itching, and discharge. Yeasts are found in the vagina of most women and can overgrow if the environment in the vagina changes. Antibiotic and steroid use is the most common reason for yeast overgrowth. However, pregnancy, menstruation, diabetes, and birth control pills can also contribute to developing a yeast infection. Yeast infections are more common after menopause.
• Any person who has their immune system altered by disease (for example, HIV infection) or other reasons (for example, chemotherapy) is at higher risk to get a yeast infection. In some people, a yeast infection, especially if it is severe and/or recurrent, may be an indication that the person has a depressed immune system.

Signs and symptoms of a candidal infection can vary depending on the location of the infection.

• In women, signs and symptoms of a vaginal yeast infection are a white cottage cheese-like discharge that typically itches and irritates the vagina and surrounding outer tissues. Occasionally, pain may occur with sexual intercourse or burning may occur with urination. This same type of yeast infection in men can cause redness, a red rash with white spots, soreness, discharge, and peeling of the skin of the penis. Blisters are not usually associated with vaginal yeast infections and may be a sign of another type of infection such as herpes.
• In infants and adults, a candidal infection can appear many different ways.
  • Oral candidiasis (thrush) causes thick, white, lacy patches on top of a red base on the tongue, palate, or elsewhere inside the mouth. These patches sometimes look like milk curds but cannot be wiped away as easily as milk can. If the white plaques are wiped away with a cotton swab, the underlying tissue may bleed. This health infection may make the tongue look red without the white coating. Thrush can be painful and make eating difficult.
  • Candidal organisms naturally live on the skin, but a breakdown of the outer layers of skin promotes the yeast's overgrowth. This typically occurs when the environment is warm and moist, such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp, scalloped edges. Smaller patches of similar-appearing rash, known as "satellite lesions" or "satellite pustules," are usually nearby. These rashes may be hot, itchy, or painful.
  • Intertrigo appears as softened red skin in body fold areas.
  • Candidal paronychia appears as nail fold swelling.
  • Mucocutaneous candidiasis appears with nail abnormalities.
  • Erosio interdigitalis blastomycetica occurs in the finger webs.
• Oral thrush requires medical treatment and a visit to a health care professional. If children take no fluids for longer than 12 hours, contact the child's doctor. Any fever or prolonged problems with feeding or a significant decrease or absence of urine production are health problems that warrant a visit to a doctor or the emergency department.
• Diaper rash or other candidal infections on the skin can be treated with antifungal creams and lotions such as clotrimazole.
  • If the rash worsens at any time or if the lesions do not clear up in one to two weeks, call a doctor.
  • Fever, chills, nausea, vomiting, or the rash spreading to other parts of the body may be a sign of a more serious illness.

Ringworm is another type of fungal infection that is different from a yeast infection. Ringworm is caused by a type of fungus called a dermatophyte, and symptoms include rashes or scaly patches that may be ring-shaped. Ringworm can cause athlete's foot, jock itch, scalp infections, and infections of the nails and skin folds.

Most cases of candidiasis do not have to be treated in the hospital. People with weakened immune systems may have more serious infections and may need to be hospitalized.

• Routine candidal skin infections rarely require hospital treatment. See a doctor if you suspect a yeast infection to receive a diagnosis and recommendations for medication and treatment.
• Women should go to the hospital when fever, chills, nausea and vomiting, or abdominal pain accompanies vaginal discharge. These symptoms can indicate a more serious health problem such as a kidney infection, appendicitis, or pelvic inflammatory disease. These potential conditions need to be promptly investigated.
• If thrush interferes with drinking liquids or eating for long periods of time, people may need to be hospitalized to receive more aggressive medications and to reestablish body fluids. Severe dehydration is an emergency.
• People with weak immune systems run the risk of the candidal organisms growing in their blood or internal organs, which can cause life-threatening illness. Intravenous (IV) medication may be necessary to combat this systemic illness.

For healthy people, most physicians can diagnose a candidal infection without laboratory tests. Occasionally, if the infection will not go away or if it involves the entire body, more extensive tests may be performed.

• One way to diagnose a vaginal yeast infection is with a full gynecologic exam.
  • This exam includes using a specialized instrument (speculum) to hold open the vagina. The exam can be uncomfortable because of pressure against the tissues. The doctor takes a swab of the discharge and may obtain other cultures to rule out other diseases. The swab for yeast is mixed with a drop of potassium hydroxide and is placed on a slide. If yeast is present, a specific branching pattern is seen through the microscope.
  • The doctor then may insert two fingers into the vagina and gently press on the uterus, ovaries, and surrounding areas to check for any tenderness or other problems. The doctor also may take blood and urine specimens after this exam. Women should not douche or have sexual intercourse one to two days before the exam because doing so may make the diagnosis more difficult.
  • Over-the-counter pH testing kits are available to help women differentiate common bacterial infections. However, people may still need to visit their doctor to confirm the cause of symptoms and to obtain the appropriate treatment.
• In healthy children and adults, a quick exam in the mouth or of the skin usually confirms the diagnosis of candidiasis. If confusion exists about the diagnosis, the doctor may obtain a small scraping of the area, which is placed on a slide with potassium hydroxide and examined for a branching pattern consistent with yeast. Sometimes a doctor removes skin flakes with a scalpel and puts the flakes onto a slide with a drop of potassium hydroxide and looks for the pseudohyphae (branches without walls or compartments) that may confirm the microscopic appearance of the Candida fungus.

Most candidal infections can be treated at home with over-the-counter or prescription medication and can clear up within a week. If some other disease has weakened a person's immune system, the person should consult a doctor about new symptoms before attempting self-treatment because of the risk of infection.

When using a nonprescription vaginal medicine for a vaginal yeast infection, follow the directions on the package insert. In addition, symptoms and signs may also be eased with some home remedies.

• Vaginal yeast infections
  • Most women can treat vaginal yeast infections at home with nonprescription vaginal creams or suppositories.
  • Eat a balanced diet. Foods with Lactobacillus organisms, such as yogurt or acidophilus milk, may help maintain healthy vaginal pH.
  • Use pads instead of tampons while using nonprescription vaginal medicines.
  • Avoid using soap when cleaning the vaginal area and rinse with water only.
  • If sexual intercourse is painful, avoid it. Otherwise, use a water-soluble lubricating jelly (such as K-Y Jelly) to reduce irritation.
  • If the genital area is swollen or painful, sit in warm water (a sitz bath) or use a cool, damp cloth on the area.
• Thrush
  • For oral thrush, swish the antifungal agent nystatin (Bio-Statin, Mycostatin, Nilstat) around in the mouth and then swallow the liquid. Maintain good oral hygiene.
  • All objects put into a child's mouth should be washed or sterilized before and after each use.
  • Breastfeeding mothers should be evaluated for Candida infection of the breast.
  • Dentures should be cleaned thoroughly after each use, and denture wearers should practice good oral hygiene.
  • In addition to nystatin, adults and older children have several treatment options not available to babies, such as troches (antifungal lozenges) or pills such as fluconazole (Diflucan) to help clear the infection instead of nystatin.
• Skin and diaper rash
  • Clotrimazole (Lotrimin) creams and lotions can be applied to superficial skin infections. Other medications require a prescription and a visit to a doctor.
  • Other antifungal creams, such as ketoconazole (Nizoral), which is available by prescription, are helpful as well, but work no better than over-the-counter preparations such as clotrimazole.
  • For paronychia, avoiding moisture can be useful. Topical antifungal and topical corticosteroids are also used.
  • Perlèche is treated with topical antiyeast or antifungal agents and often with a mild corticosteroid cream. Limit lip licking of the corners of the mouth. Placing a bit of petroleum jelly on top of the antiyeast agents can be helpful, as well.
  • The affected area should be kept clean and dry.
  • For diaper rashes, frequent diaper changes and the use of barrier creams speed recovery. Nystatin powder decreases the amount of moisture and also acts as an antiyeast agent.

Other home remedies touted to treat yeast infection include apple cider vinegar, which may have some antifungal activity against Candida albicans. A 2011 study in the Thi-Qar Medical Journal compared apple cider vinegar to fluconazole, an antifungal medication, and suggested that apple cider vinegar may be used for antifungal treatments.

Tea tree oil is also a natural disinfectant that may be applied topically to treat skin yeast infections. In some cases, tea tree oil is used to soak a tampon, which is then inserted vaginally to treat a vaginal yeast infection. Use caution with this method as anything inserted into the vagina can cause irritation. Consult your doctor before using any home natural remedy, as they may have unwanted side effects, allergic reactions, or interactions with medications you use.

A wide array of treatment options are available to treat candidiasis. Options include creams, lotions, ointments, tablets or capsules, troches (lozenges), and vaginal suppositories or creams. Talk to a doctor to find the option that is right for you.

• Yeast infections may be treated by a family practitioner or internist.
• Women who have vaginal yeast infections may be treated by a gynecologist.
• Children who have a yeast infection may see their pediatrician.
• Oral thrush may be treated by a dentist.
• Severe cases of skin yeast infections may be treated by a dermatologist.
• If symptoms are severe, you may go to a hospital emergency department where you will be seen by an emergency medicine specialist. Rarely, an infectious disease and/or a critical care specialist may help treat the most severe infections.

Medications used to treat yeast infections generally fall into two main categories.

• Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast die. Because ergosterol is not a component of human membranes, azoles do not harm human cells.
• Polyene antifungal medications include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast wall that cause the yeast to leak and die.

Oral antifungal agents may be used for a variety of skin or vaginal infections.

• Nystatin (Nilstat, Mycostatin) is commonly prescribed for oral thrush. The oral liquid is administered with a dropper to adequately coat the inside of the mouth in infants and young children. Troches (lozenges) may be prescribed for older children and adults with oral thrush.
• Clotrimazole (Mycelex) troches are also available for treating oral thrush in older children and adults and are more effective than nystatin.
• Fluconazole (Diflucan) and itraconazole (Sporanox) are prescription products administered as tablets or oral liquid. They may be used when topical agents are ineffective, large areas of skin is affected, or for individuals at a higher risk of fungal infection, such as patients with cancer or HIV.
• Fluconazole is also used to treat vaginal Candida infections.
• Terbinafine (Lamisil) is an oral antifungal used to treat nail and skin fungal infections. This medication is also commonly used to treat athlete's foot, another type of foot fungal infection.
• These oral antifungal drugs interact with many medications. Your doctor and pharmacist should be aware of all medications that you are taking, including nonprescription drugs and herbal products.
• The most common side effects of antifungal medications include nausea, vomiting, and abdominal pain.
• The doctor will periodically draw blood samples to monitor for the rare toxicity of liver impairment for those patients on long-term medications, although long-term treatment is seldom needed.

Naftifine (Naftin) is a 2% gel is used to treat fungal skin infections the respond poorly to other antifungals; other antifungal agents are being actively researched.

Vaginal creams, ointments, and suppositories include butoconazole (Femstat), clotrimazole (Femizole-7, Gyne-Lotrimin), miconazole (Monistat Vaginal products), terconazole (Terazol), and tioconazole (Vagistat).

• Follow the manufacturer's instructions for one to seven days depending on the formulation. If the irritation increases, immediately discontinue the medication. Some products contain topical antifungal cream to use on irritated external genital areas along with vaginal cream or suppositories.
• Pregnant women should consult a doctor before using these treatments.
• If symptoms continue for more than one week despite treatment, consult a doctor. These symptoms may be caused by something other than a fungal infection.
• People who have abdominal pain, fever, or offensive-smelling vaginal discharge should consult their physician before using these products.

Fungal infections thrive in moist, enclosed areas. The following instructions are important to prevent and treat skin and vaginal fungal infections.

• Keep the skin free from persistent moisture.
• Shower thoroughly after activities that produce sweat and dry areas prone to fungal infection.
• In infants, keep the diaper area dry.
• Cotton underwear may help prevent excessive moisture for women who are prone to vaginal infections.
• Try to maintain the healthy fungus/bacteria balance in the vagina by eating yogurt or taking Lactobacillus acidophilus capsules.

In most cases, yeast infections including vaginal yeast infections, thrush, and diaper rash will go away completely within one to two weeks when treated appropriately.

Complications of yeast infections include the infection returning, excessive scratching may cause cracking of the skin that could lead to a secondary skin infection, and a yeast infection of the nails may cause the nails to become misshapen. In people with compromised immune systems (those who have HIV, cancer, or diabetes), widespread candidiasis may occur.

If you have recurring yeast infections, or a yeast infection that does not respond to treatment, it may be an early sign of another disorder such as diabetes or HIV.