Frederick A. J. Kingery

Don't Forget About Candidiasis

A surgeon was seen by a colleague because of an irritation in the groin. On the assumption that this was a simple intertrigo or seborrheic dermatitis, he was given a topical preparation containing neomycin sulfate, bacitracin, polymyxin B sulfate, and hydrocortisone, with the assurance that all would be well shortly. Instead, the eruption became progressively more acute. After a week of such treatment the now-incapacitated surgeon had a raw, weeping, painful dermatitis of the entire perineum (Fig 1) and a similar eruption in the axilla (Fig 2). A diagnosis of candidiasis was made clinically and confirmed by examination of a scraping in potassium hydroxide. The yeast had thrived on a diet of steroids and antibiotics. The involved skin was a beefy red color and contained large colonies of yeast, grossly visible as a curd-like white exudate. Beyond the semidistinct scalloped border of the eruption were many satellite lesions, each one