A 60 year old male presents with a creamy curd like white patch on the tongue. The probable diagnosis is -
creamy curd like white patch on tongue is diagnostic of candidiasis. In lichen planus ,Classic lesion- small polygonal shaped, and red/ violet, flat topped papule. Four Ps- purple polygonal pruritic papule. In histoplasmosis-lesions are erythema nodosum like lesions,erythema multiforme like lesions and non specific lesions appear as papules,pustules and nodules. Candidiasis/ moniliasis Superficial infection of skin and mucous membranes by yeast Candida. albicans. Sometimes systemic spread occurs causing systemic disease. Candida is yeast that produces budding cells, pseudohyphae and hyphae. Most common species: Candida albicans and Candida tropicalis. Sites of carriage: Cutaneous: body orifices and fingers, moist interigenous areas. Gastrointestinal: oral cavity,rectal other pas of GIT yeast forms are present. Vaginal : health vagina colonise yeasts Pathogenic forms: pseudohyphae and hyphae Predisposing factors for Candida infection: Extremes of age Illness Tissue damage diabetes Immunodeficiency Antibiotics Cushings Addisons Hypothyroidism HIV CLinical presentation Cutaneous candidiasis: Flexural candidiasis/ interigo-involves skin folds. Minor erythematous exudates fringed edge and satellite pustules are characteristic. Perleche is candidiasis at corners of mouth, erosio interdigitalis blastonycetia candidiasis of web spaces. Napkin candidiasis Candidal miliria Candidal paronychia- swelling and redness of nail folds Neonatal candidiasis: presents after 6th day as diaper dermatitis or thrush Oral candidiasis: Oral thrush: curry white patches covered by pseudo membrane Candidal leukoplakia Median rhomboid glossitis Angular chelates/perleche Vulvovaginal candidiasis: presents as white discharge curdy white with erythema Candidal balanitis: linear fissures, erythematous areas with circinate borders Chronic mucocutaneous candidiasis systemic candidiasis- esophageal, bronchial type Investigations Direct determination of pseudohyphae and yeasts: KOH Mount and grams stain Culture:saborouse dextrose agar Reynolds braude phenomenon:when Candida grown in human or sheep serum at 37 c for 3 hrs, forms germ tubes. It is positive for Candida albicans and Candida dubiliniensis. Treatment: antifungals azole group of drugs Iadvl textbook of dermatology page 254
Candidiasis
Histoplasmosis
Lichen planus
Aspergillosis
Fungal infections, Scabies, Pediculosis