Clinical forms of fungal skin and appendages

Candidiasis intertriginous (Candidiasis intertriginosa)
This condition is usually caused by Candida Albicans. Inflammatory changes in fungal intertriginosa often develop in people with diabetes and are sometimes the first symptom to suggest the development of this disease. Characteristic of this disease is erythematous dermatitis inflammation of the skin, within which there is excessive peeling and cracking of the epidermis, the emergence of itching erosion and serous fluid percolation. They usually exceed the area of mutual adhesion of the folds of the skin. In the further course of exfoliation a dark-colored, glistening and moist area of the skin is revealed. The outbreak is separated from the skin by a healthy piece of detached epidermis. Characteristic is the appearance in the vicinity of these changes of erythematous outbreaks called squamous satellites. Below I present intertriginous diseases, whose classification was based on location.

Candidiasis intertriginous of intergluteal and perianal areas (candidiasis intertriginosa interglutealis et perianalis)
This disease is among the most common, persistent and most unpleasant. It is associated with the infection of the distal colon.

Candidiasis intertriginous of the inquinal area(candidiasis intertriginosa inquinalis)
These changes may develop along with an intergluteal intertriginous candidiasis or may occur independently.

Candidiasis intertriginous of submammary (candidiasis intertriginosa submammaris)
These changes occur mostly in obese women with flabby breasts.

Candidiasis intertriginous of the interdigital area (candidiasis intertriginosa interdigitalis pedum)
Changes that occur in the skin in this disease are described in the paragraph about athlete’s foot. The only symptom differentiating these two diseases is the appearance of the small bubbles on the perimeter of the inflammation outbreak; the adjacent toes are glued together by congealed secretion.

Candidiasis intertriginous of the hand separator (erosie interdigitalis candidamycetica)
It is usually a single outbreak in the third space separator. Outbreaks of inflammation are sharply demarcated from the surrounding area. The layer of detached epidermis is dark red and glossy as if varnished.

Cheilitis (Inflamation of the lips) ( Cheilitis Candidamecetica) and Angular Cheilitis ( Angelus infectious oris)
This disease is a consequence of fungal infection transferred from the mouth to the adjacent area. A habit of licking the lips and drooling may turn it into a chronic condition.

Morphologic characteristics of intertrigo and fungi
Morphologic difference between intertrigos versus vesicular and papular eruptions in the fungal infection of the groin, is their location. In intertrigos, skin lesions are located deep in the folds of the skin, while in the fungal infections on their circumference. Location of lesions within the folds of the skin fosters the development of fungal infection because of the existence of favorable conditions such as elevated temperature, humidity, and the mechanical irritation in the groin (due to movement), which breaks the epidermal continuity. The diagnosis should be established through the laboratory assessment of the tissue. Mycological culturing on substrates can also be performed.

Outside the folds of skin mycosis (candidiasis cutis glabrae)
Inflammation of the skin develops from small intertrigenous outbreaks. It tends to expand occupying vaster and vaster parts of the skin with jagged and overlapping borderlines.

Diaper mycosis
It develops as the result of improper infant care and occupies mostly the area of the buttocks and abdomen, but may spread to the entire surface of the skin.

Nipple areola mycosis (areolae mammae candidiasis)
It develops on the nipple and its surroundings in nursing mothers. Inflammatory changes are erythematous-scaling or vesicular. The process is limited to the nipple. Drooling and oral thrush in the newborn fosters the development of this disease.

Fungal infection of hair follicles (candidiasis follicularis)
Infection of hair follicles develops in men’s beards or in other parts of the body; for example around scrotum. Characteristic is the swelling around the orifice of the hair follicles.

Athlete's foot (Tinea interdigitalis intertriginosa)
One of the factors causing this disease is the fungus Candida Albicans. It frequently occurs in soldiers wearing tight shoes. The disease process begins in the IV toe separator and spreads to the folds between adjacent toes. Because the outbreaks are itchy, the infection spreads through scratching. In the initial phase of the disease, translucent bubbles appear on the skin between the toes. The bubbles burst. Epidermis becomes white, pulpy and macerated. It exfoliates and uncovers bare pink glossy wet surface. Maceration spreads onto subungual folds, then toes and adjacent space on the back of the foot.

Onychomycosis (candidiasis unquium)
The most common symptom of this disease is paronychia, which is characterized by the presence of acute or chronic inflammation of the soft tissue surrounding the nail, usually caused by Candida Albicans or C. Parapsilosis. Most infections occur in people with frequent contact with water – kitchen help, cleaners, etc. The process initially involves the first two nails and then the rest of them. The main symptoms of the infection are pain and swelling of the nail fold, leaking purulent secretions. The edge of the nail plate may be purulent, and may separate from the soft tissue. With time the nails become yellow - greenish, they lose their luster, they become hypertrophic and divide into layers. Paronychia can also be caused by bacteria, and for this reason, the direct microscopic examination or culture is crucial for the proper diagnosis. Mixed infections, both fungi and bacterial also occur frequently. With the progression of the disease the nail plate may be completely destroyed.

Granulomatous mycosis (candidiasis granulomatosa)
This condition is a consequence of impaired cellular immunity. It develops in early childhood on the scalp, in the area of orifices of the face, in the auricles, as well as palms and soles of the feet. Dark yellowish scabs appear on the skin and they grow forming solid, thick, brittle layers.

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