本文总结了有关影响皮肤和口腔粘膜的念珠菌病的诊断和治疗的最新知识。粘膜皮肤念珠菌病的几种临床形式根据患者的年龄和感染部位进行区分。例如假丝酵母,支原体婴儿红斑,洋地黄,念珠菌甲沟炎和甲沟炎,念珠菌甲癣,和口腔念珠菌病。通过在显微镜检查中观察菌丝形式来确认念珠菌病的诊断。由于念珠菌(尤其是白色念珠菌)是皮肤和口腔粘膜的正常居民,必须始终注意,阳性培养并不总是表明念珠菌感染的存在。念珠菌的致病性相对较低,真菌侵入组织需要一些特殊的条件。诱发因素,如皮肤和粘膜微环境紊乱和全身或局部免疫抑制,反复感染的患者应进行检查。皮肤念珠菌病的治疗以局部抗真菌药为主。Azole抗真菌乳膏(例如,联苯苄唑,酮康唑,盐酸奈替康唑,兰诺康唑和卢立康唑)是最有效的。盐酸特比萘芬和盐酸阿莫洛尔芬也是有用的。皮肤念珠菌病通常需要比浅表皮肤癣菌感染更短的局部治疗时间(1-2周)。对于念珠菌甲沟炎和甲癣,建议口服伊曲康唑。伊曲康唑的每日剂量应服用数月,而其用于念珠菌病的脉冲疗法在日本未获批准。伊曲康唑口服液常用于口腔念珠菌病,和咪康唑凝胶也是有效的。
This document summarizes current knowledge about diagnosis and treatment of candidiasis affecting the skin and oral mucosa. Several clinical forms of mucocutaneous candidiasis are distinguished depending on a patient\'s age and infected site, e.g. Candida intertrigo, erythema mycoticum infantile, erosio interdigitalis blastomycetica, candidal paronychia and onychia, Candida onychomycosis, and oral candidiasis. The diagnosis of candidiasis is confirmed by observation of mycelial forms on microscopic examination. Since Candida yeasts (especially C. albicans) are normal inhabitants of the skin and oral mucosa, it must always be noted that positive culture does not always indicate the presence of candidal infection. The pathogenicity of Candida species is relatively low, and some special conditions are required for tissue invasion by the fungus. Predisposing factors, such as disturbances of the cutaneous and mucosal microenvironment and systemic or local immunosuppression, should be checked in patients with recurrent infection. Therapy for cutaneous candidiasis is dominated by topical antifungal agents. Azole antifungal cream (e.g., bifonazole, ketoconazole, neticonazole hydrochloride, lanoconazole and luliconazole) is most effective. Terbinafine hydrochloride and amorolfine hydrochloride are also useful. Cutaneous candidiasis usually requires a shorter duration of topical treatment (1-2 weeks) than superficial dermatophyte infections. For candidal paronychia and onychomycosis, oral therapy with itraconazole is recommended. The daily dose of itraconazole should be taken for several months, while its pulse therapy for candidiasis is not approved in Japan. Itraconazole oral solution is commonly used for oral candidiasis, and miconazole gel is also effective.