Effect of candicidin in intertriginous and paronychial moniliasis

Prevention and treatment of intertrigo in large skin folds of adults: a systematic review

BACKGROUND

Intertrigo in the large skin folds is a common problem. There is a plethora of treatments, but a lack of evidence about their efficacy. A nursing guideline on this matter had to be updated and broadened in scope to other health care professionals.

METHODS

A systematic review was performed. Thirteen databases were sensitively searched, supplemented by reference tracking and forward citation searches. All types of empirical research relating to the prevention or treatment of intertrigo were included. Study selection, assessment of bias, data-extraction and analysis were done by two independent review-authors.

RESULTS

Sixty-eight studies fulfilled the inclusion criteria. Only 4 studies were RCTs and even these had a considerable risk of bias. Study populations were generally small.No studies were found about the prevention of intertrigo. The therapies concerned mostly the topical application of antimycotics, corticosteroids, antibiotics, antiseptics or a combination of these. Besides these pharmaceutical interventions, surgical breast reduction was also studied. Although most study-authors were positive, we could not draw firm conclusions about any of the pharmaceutical interventions. Even patients that received placebo intervention showed improvement. There is weak evidence that reduction mammaplasty may be helpful to treat inframammary intertrigo. All research found had considerable risk of bias, prohibiting firm conclusions.

CONCLUSIONS

There is no evidence at all about the prevention of intertrigo and there is no firm evidence about its treatment. Well designed studies are needed.

An evolution of therapy for mucocutaneous candidiasis

Chronic mucocutaneous candidiasis is a relatively uncommon form of candida infection, and can be found in patients with primary deficiencies of their immune systems. When such infection occurs in patients with non-lethal immune deficiences defects of chemotaxis or cellular immunity can be found. In addition, significant endocrinopathies may occur, particularly involving the parathyroid and adrenal glands. A number of therapies have been devised for the treatment of chronic candidiasis, and have included both local and systemic medications. The most useful of these in the past have included the polyene antibiotics -- most notably, nystatin and amphotericin B. Antifungal activity has also been demonstrated clinically with the use of 5-fluorocytosine (a fluorinated pyramidine) and clotrimazole (a synthetic imidazole derivative). However, long-term therapy with medication has been required, and re-emergence of symptomatic infection has occurred when medications have been stopped. More recently, immune reconstitution with transfer factor has been employed in the treatment of patients who have been found to be anergic to candida. Such treatment in conjunction with chemotherapy has indicated that effective patient remissions can be obtained in those patients who develop and maintain cell-mediated immunity to candida. Twelve patients with chronic mucocutaneous candidiasis are profiled. Sites of involvement in the head and neck included the skin and hair (9), ears (9), nose (4) and throat (12). One patient had candida laryngitis, while five patients had evidence for esophageal disease. Of this latter group, one (a 5-year old boy) developed esophageal stenosis which required gastrostomy and retrograde esophageal dilatations. Nine patients were found to be anergic to candida. In these patients, systemic chemotherapy (as amphotericin B or 5-fluorocytosine) was used to induce remissions of disease and transfer factor was given to induce reactivity to candida. By so doing, topical or oral medications (utilizing miconazole, clotrimazole and nystatin) were found to suffice in maintaining effective local control of infection.