Key concepts

0 The predominant pathogen associated with vulvovaginal candidiasis (VVC) is Candida albicans, although a small percentage of cases are caused by C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis.

01 A variety of factors including antibiotic use, diabetes, and immunosuppression may increase the risk of developing symptomatic VVC. No risk factors are consistently associated with any case of VVC.

Asymptomatic vaginal colonization of C. albicans is not diagnostic of VVC since 10% to 20% of women are asymptomatic carriers of Candida species. Asymptomatic vaginal colonization does not require treatment.

^^ Selection of antifungal agents to treat uncomplicated VVC is influenced by patient preference, including route of administration, duration of therapy, cost, risk of adverse effects, and potential for medication interactions.

^ Recurrent VVC, defined as four or more infections per year, requires long-term suppressive therapy for 6 months.

® The occurrence of oropharyngeal candidiasis (OPC) and esophageal candidiasis is an indicator of immune suppression, often developing in infants, the elderly, and the immunocompromised.

Topical antifungal agents are first-line therapy for OPC, although oral agents may be used for severe or unresponsive cases.

® Esophageal candidiasis is a severe extension of OPC that requires oral antifungal therapy.

O Since dermatophyte hyphae seldom penetrate into the living layers of the skin, instead remaining in the stratum corneum, most mycotic infections of the skin can be treated with topical antifungals. Infections covering large areas of the body or infections involving nails or hair may require oral therapy.

© Onychomycosis, fungal infections involving the nails, requires oral antifungal therapy. Topical agents do not adequately penetrate the nail.

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