A Woman, 59 Years Old with

Intertrigo Candidiasis

A R F Y A N D A
G99172045

Dr. Nugrohoaji Dharmawan, Sp. KK, FINS DV, FAA DV

 Introduction

Candida species are associated with human beings for

quite long time as harmless commensals. They are
commonly found on the mucosal surfaces of
gastrointestinal and genitourinary tracts and skin of
humans.

However, they become opportunistic pathogens in

immunologically weak and immunocompromised
patients. As opportunistic pathogens, they can cause local
mucosal infections and sometimes, systemic infections in
which Candida species can spread to all major organs and
colonize in these organs
Etiology
 Major types of candidiasis

Mucosal candidiasis
Candidal infections are restricted to non-sterile
mucosal surface for example oropharyngeal and
vulvuvaginal candidiasis
 Oropharyngeal candidiasis (OPC)
 Oral candidiasis is one of the
most common, oral mucosal
infections seen in persons with
HIV
 Host local predisposing
conditions comprise: (i) reduced
saliva secretion, (ii) epithelial
changes and local mucosal
diseases, (iii) changes in
commensal flora, (iv) high
carbohydrate diet (v) denture
wearing
 Vulvovaginal candidiasis (VVC)

 Vaginal candidiasis is the most

frequent reason for gynecology
consultation in primary health
care services
 The symptoms associated with
VVC are eczematoid dermatitis
lesions that sometimes show
vesicular and grey-white
psuedomembrane, vulval
pruritis, burning, erythema and
curd like discharge
 Cutaneous candidiasis
Cutaneous candidiasis is usually secondary infection of skin and nail
(body folds) in predisposed patients.

Disease involvement may be localised or generalised to the skin or

nails.
The spectrum of cutaneous candidiasis includes diaper rash, intertrigo
candidiasis, Candida folliculitis, Otomycosis, Onychia and Paronychia.

It usually occurs in warm, moist and creased area, such as axillary

folds, inguinal or intergluteal areas. It is fairly common opportunistic
disease and usually lead to maceration and trauma in skin. It is
commonly found in diabetics and obese people. Other predisposing
factors are antibiotic and oral contraceptives become macerated
 WORK UP
 Anamnesis and clinical findings
 Laboratory findings :
Pseudohyphae and Budding yeast cell

Budding yeast cell

Pseudohyphae
Therapy
 IDENTITY

• Name : Mrs. S
• Age : 59 y.o
• Address : Magetan, East Java
• Status : Married
• Medical Record : 01 45 1XXX
• Date of Examination : March, 4𝑡ℎ 2019
 ANAM NESI S
Chief complaint:
Reddish itchy-patch on genital and inguinal.
 Present Ilness

The patient is consulted by Internist with diagnose of

Complicated Urinary Tract Infection, Ren Cyst, and
Uncontrolled Diabetes Mellitus type II. The patient is
consulted due to there is reddish patch on genital and inguinal.
The patient complain about there is reddish patch on genital
and inguinal that continuously itchy especially when she was
sweating so that she scratch on it. First, it’s started with
reddish patch since ±3 weeks ago in the genital and then
spread out to the inguinal.
The patient also complaining of having white-
yellowish thick liquid and not smelly but
sometimes it formed like cheese and stick on her
panty. Beside that, lately she also complain she
got stomatitis.
From Alloanamnesis, her daughter said that she
is immobilize, and she did not take shower
regularly, only washed a part of her body and
changed her cloth once a day.
 History of Present Illness

• History of the similar disease (-)

• History of allergy (-)
• History of asthma (-)
• History of hypertension (-)
• History of diabetes (+),
since 6 years ago and uncontrolled
 History of Family Illness

• History of the similar disease (-)

• History of allergy (-)
• History of asthma (-)
• History of hypertension (-)
• History of diabetes (-)
 Social Economic History

The patient is a housewife. Patients using BPJS

facilities.
 PHYSICAL EXAMINATION

 GCS E4V5M6, Compos Mentis

 Blood Pressure : 130/80
mmHg
 Heart Rate : 63 x/min
 Respiration Rate : 20 x/min
 Temp : 36,90 C
 Weight : 40 kg
 Height : 155 cm
 BMI : 17, 6 kg/ 𝑚2
 Dermatovenerology status

Genitalia and ingiuinalis dextra et sinistra region :

Erythematous patches, multiple, discret, partly
confluens with erosive on some areas, Satelite
lession (+), white-yellowish thick liquid like
cottege chesee form.
Genital and Inguinal dextra et sinistra regio
 DIFFERENTIAL DIAGNOSIS

Intertrigo Candidiasis
Intertrigo Dermatitis
Eritrasma
Dermatophytosis (Tinea Cruris)
 Laboratory Examinations

KOH examination (+)

Pseudohyphae
Budding yeast
cell

Pseudohyphae (+) and Budding yeast cell (+)

 Diagnosis
Intertrigo Candidiasis
Plan : Pro Internal Examination
 Treatment
Non pharmacology
1. Educate the patients about illness, symptoms, infection, drug
information, side effect of the drugs, complication, and it’s
prognosis.
2. Educate to keep body hygiene.
3. Educate not to scratch the lessions.
4. Educate to keep the infected area skin are not to get damp for
examples to change the diaper when it’s wet.
5. Not wearing tight cloths to avoid friction and wearing absorbable-
cloth material.
6. Educate not to exchange toiletries and cloth with the others and
wash the possibly infected towel or cloths
7. Education about obedience of consuming drugs and improves
family support
Pharmacology

Miconazole cream 2% 2x/day on erythem

lession (morning and evening)
Mupirocyn ointment 2% 2x/day on erosive
lession (afternoon and night)
Cetirizine tablet 10mg once a day
 PrognosIs

Ad vitam : dubia ad

bonam
Ad sanam : dubia ad bonam
Ad fungsionam : dubia ad
bonam
Ad cosmeticum : dubia
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Thank you