Candida Albicans: What is the most medically-sound, effective way to treat candida overgrowth? Dr. Emily Altman’s answer on Quora.com
In healthy individuals, in the head and neck area Candida albicans can be found in the oral cavity and in the external ear as a colonizer. It is very rare to have a Candida albicans rash on the face, other than in angular cheilitis (inflammation of the corners of the mouth, perleche). Candida albicans is also a cause of thrush in neonates, immunosuppressed individuals and people who recently took systemic antibiotics.
Candida is also normally found in body folds, like axilla, under the breasts, in the finger and toe webs and groin/vulvar/perianal areas. It can overgrow and cause a rash in people on antibiotics, people with diabetes or in overheated and moist conditions like wearing a diaper.
Candida can cause widespread skin rashes in immunocompromised individuals and in people with certain rare congenital disorders where the immune system has trouble dealing with Candida, such as chronic mucocutaneous candidiasis.
Depending on the circumstances, there are contributing factors to angular cheilitis, that create a pocket of skin where saliva can pool, such as in people with braces or poorly fitting dentures. People that chronically lick their lips, usually from dryness, deposit both saliva and microorganisms that live in the mouth onto the skin. All of these lead to an irritation and breakdown of the skin in the mouth corner areas. People with eczema/atopic dermatitis are prone to having angular cheilitis.
Using a combination of an antifungal cream (one of the -azoles, not terbinafine) to treat the Candida and a mild corticosteroid cream to treat the inflammation on a decreasing schedule usually helps. As the medications are being decreased, application of petroleum jelly to the areas will help prevent saliva and Candida from irritating the area again. Poorly fitting appliances such as dentures need to be replaced, otherwise the rash will recur.
For Candida infections/overgrowth inside the mouth, swishing with a suspension of Nystatin three times a day is helpful. There are also antifungal medications in forms of sucking candy (troches) that are allowed to dissolve slowly in the mouth to treat oral Candida infections. These are prescription medications.
Angular cheilitis can have other causes, such as vitamin, zinc or iron deficiencies or malnutrition of multiple etiologies. So if the angular cheilitis is particularly florid or resistant to treatment, a workup for other causes should be done.
For people with Candida infection in body folds and finger webs, there is often not well controlled diabetes mellitus involved. Treatment with topical antifungals as well as acquiring better control of blood sugars helps.
I usually recommend that people who need to take antibiotics, take probiotics with them, such as Acidophilus to help prevent Candida overgrowth in the gastrointestinal tract.
If Candida infections are severe, then treatment with an oral antifungal, such as Diflucan, may be needed in addition to the topical treatments.
In addition, facial rashes similar to acne can be caused by a yeast called Pityrosporum, which may require oral antifungals as the yeast is in the hair follicles and hard to reach by topical meds.
Also, in patients with rosacea, there is sometimes an overgrowth of a mite called Demodex, which requires repeated treatments with permethrin to get rid of. A scraping with the dull edge of a curette and examination under the microscope can be helpful in determining if Demodex is the cause.
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