The 42-year-old man (Figure 136-1) was admitted to the hospital for community-acquired pneumonia and type 2 diabetes out of control. On the second day of admission, when he was feeling a bit better, he asked about the itching he was having on his penis. Physical examination revealed an uncircumcised penis with white discharge on the glans and inside the foreskin consistent with Candida balanitis. KOH prep was positive for the pseudohyphae of Candida. The patient was treated with a topical azole and the balanitis resolved.

Cutaneous and mucosal Candida infections are seen commonly in persons with obesity, diabetes, hyperhidrosis, and/or immunodeficiency.

Perlèche = angular cheilitis.

Candida thrush is common in normal infants and in adults may be a sign of immunosuppression (Figure 136-2).

Candida balanitis is more common in uncircumcised men than in those that have been circumcised (Figure 136-1).

• Infections caused by Candida species are primarily Candida albicans.1
  
• C. albicans has the ability to exist in both hyphal and yeast forms (termed dimorphism). If pinched cells do not separate, a chain of cells is produced and is termed pseudohyphae.1

Obesity, diabetes, hyperhidrosis, immunodeficiency, HIV, heat, use of oral antibiotics, and use of inhaled or systemic steroids.1

Clinical Features

• Typical distribution—Groin, glans penis, vulva, inframammary, under abdominal pannus, between fingers, in the creases of the neck, corners of mouth, nailfolds in chronic paronychia.
  
• Morphology—Macules, patches, plaques that are pink to bright red with small peripheral satellite lesions.
  
• Candidiasis of the nipple in the nursing mother is associated with infantile thrush (Figures 136-2 and 136-3). Nipple candidiasis is almost always bilateral, with the nipples appearing bright red and inflamed. In this case, the inflammation was made worse by the application of a topical antibiotic that caused a secondary contact dermatitis.
  
• The Candida infection in the corners of the mouth are called perlèche or angular cheilitis (Figure 136-4). When accompanied by thrush it may be a sign of HIV/AIDS.
  
• Thrush can be caused be Candida growing on the upper plate of a denture and the roof of the mouth (Figure 136-5).
  
• Ask about recent antibiotic use if there is a new onset of a rash with satellite lesions. In Figure 136-6, the man with diabetes had a course of antibiotics before he developed a Candida infection in his groin.