Etiopathogenic, clinical, and therapeutic syntheses in cutaneous-mucosal candidiasis

Abstract

Cutaneous-mucosal candidiasis is a fungal infection with acute, subacute, or chronic progression, caused by yeasts of the genus Candida, especially C. albicans, although less common other species should also be considered: C. glabrata, C. krusei, C. tropicalis, and more recently, C. auris. It occurs in both sexes (with a slight prevalence in women), in adults (in the sexually active/reproductive phase), and in the elderly (menopause, andropause, and a higher occurrence of intercurrent illnesses that predispose them to the infection), in both rural and urban environments (urban residents typically have better access to medical care). Purpose Highlighting the ethiopathogenic, clinical, and therapeutic particularities of cutaneous-mucosal candidiasis in the current context. Materials and Methods For the completion of this study, a narrative review of the specialized literature was conducted. Research methods included historical, comparative, and estimative analysis. Results and Discussions Cutaneous-mucosal candidiasis is identified in various medical fields: dermatology, stomatology, otorhinolaryngology, gynecology, urology, endocrinology etc. Patients between 18 and 35 (both men and especially women) more frequently develop urogenital candidiasis (vulvovaginitis, balanoposthitis, and/or urethritis). Patients over 55, more commonly develop oral candidiasis (stomatitis) and cutaneous candidiasis (intertrigo, onychomycosis, and perionychosis), when the underlying conditions are triggered or exacerbated (diabetes mellitus, obesity, chronic venous insufficiency, vulgar pemphigus, exudative psoriasis etc.). Major risk factors in the onset and persistence of cutaneous-mucosal candidiasis are long-term therapy with steroids, retinoids, and cytostatics, long-term use of contraceptives, and prolonged or high-dose antibiotic therapy. In women of young, reproductive age, the association of urogenital candidiasis with various sexually transmitted infections (E.g.: trichomoniasis, chlamydiosis, mycoplasmosis, gardnereliosis) is concerning. (On the other hand) In men over 50, most cases of phimosis are caused by the Candida albicans strain. Direct mycotic and cultural examination (Sabouraud medium) is necessary to ensure correct etiological treatment. Resistance to antifungals is rapidly increasing, thus antifungal susceptibility testing is mandatory in chronic forms of the infection. The most effective and accessible systemic antifungals are triazoles, in particular fluconazole. Unfortunately, resistance to this medication has increased in the last 10-15 years. In cases where yeast infection is associated with dermatophytes and/or microfungi, itraconazole is the preferred treatment. The latest generation azoles (voriconazole, posaconazole, ravuconazole) and echinocandins (caspofungin, micafungin, anidulafungin) are particularly effective against cutaneous-mucosal candidiasis, especially in immunocompromised patients (HIV/AIDS, tuberculosis, diabetes mellitus, transplant recipients). Aniline dyes (methylene blue, gentian violet), as well as imidazoles (econazole, isoconazole, butoconazole, fenticonazole), can be utilized topically. Conclusions Preventing cutaneous-mucosal candidiasis and treating it effectively is only possible through a comprehensive, interdisciplinary approach.