Review Question - QID 220791

Candida albicans Treatment Medical QID: 220791 (M2.OMB.4871)

QID 220791 (Type "220791" in App Search)

A 7-year-old girl is brought to her pediatrician by her mother with a 1 month history of rash. She first noticed the girl scratching her legs when they returned from a Caribbean vacation. Since then, she has had increasing itchiness over time. The mother became concerned when she saw red patches on the girl's legs. She does not have any other symptoms. She is otherwise healthy and does not take any medications. Her vaccinations are up to date. Her temperature is 98.7°F (37.0°C), blood pressure is 112/69 mmHg, pulse is 85/min, and respirations are 13/min. A physical examination is notable for the findings shown in Figure A. Which of the following is the most appropriate medication for this condition?

Type & Select Correct Answer

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Permethrin cream

0/1

Petroleum jelly

0/1

Topical hydrocortisone

100%

1/1

Topical nystatin

0/1

Zinc oxide

0/1

Select Answer to see Preferred Response

This patient, who presents with a well-demarcated, erythematous, and pruritic rash involving the posterior aspect of the knee, most likely has a candidal skin infection. The most appropriate treatment for a localized candidal skin infection is topical nystatin.

Erythematous rashes of the intertrigo skin folds are a common clinical presentation in the pediatric population. Some causes of this complaint include atopic dermatitis, seborrheic dermatitis, irritant contact dermatitis, candidal infection, parasitic infestations, and Langerhans cell histiocytosis. Cutaneous candida infection is characterized by well-demarcated, erythematous, and macerated plaques that are pruritic. Visualization of yeast and pseudohyphae on histology confirms the diagnosis. Topical nystatin is the treatment of choice for localized cutaneous Candida infection. Refractory cases can be treated with systemic azoles.

Taudorf et al. reviewed the efficacy and adverse effects of topical and oral therapies for cutaneous candidiasis in all age groups. They discuss how oral fluconazole can be used for systemic treatment of cutaneous candidiasis. They recommend starting with topical treatment for localized cases.

Figure/Illustration A is a clinical photograph demonstrating a well-demarcated and erythematous rash in the knee flexion folds (red circle). These findings are characteristically seen in a candida skin infection.

Incorrect Answers:
Answer 1: Permethrin is used in the treatment of scabies, which is caused by Sarcoptes scabiei. Scabies is an intensely pruritic skin condition that is worse at night and commonly affects the finger webs, waistline, genitals, feet, ankles, and wrists. The inflammatory reaction results in erythematous and eczematous papules and occasionally blisters.

Answer 2: Petroleum jelly is an emollient and effective therapy for general xerosis or atopic dermatitis. Patients with atopic dermatitis typically present with erythematous, scaly rashes involving the facial cheeks and the extensor surfaces of the knees and elbows. While this treatment may aid in symptom reduction through lubrication and emollient effects, it does not address the underlying etiology of a fungal infection.

Answer 3: Topical hydrocortisone cream is an effective therapy in seborrheic dermatitis. Seborrheic dermatitis classically presents as erythematous papules and plaques with a greasy yellow scale, most prominent in the skin folds. Topical corticosteroids would not aid with treating the fungal infection and may predispose to the fungal infection from seeding deeper, such as in a Majocchi granuloma.

Answer 5: Zinc oxide is an excellent barrier protection therapy that is useful in cases of irritant contact dermatitis. Zinc oxide may provide symptomatic relief in candidal infection, but would not treat the underlying fungal or inflammatory process.

Bullet Summary:
Topical nystatin is the treatment of choice for localized candida skin infections.