Non-superficial Cutaneous Manifestations by Candida Species

To define adequate terminology regarding non-superficial or deep cutaneous manifestations of infection by Candida, as well as to describe the most common causal species, clinical manifestations, and treatment options.

The prevalence and clinical significance of non-albicans Candida species have been increasing. Research has better characterized these emerging fungi.

Candidiasis ranges from superficial mucocutaneous infections to invasive manifestations, including candidemia and organ involvement. Invasive candidiasis (IC) includes candidemia (Candida in the bloodstream) and deep-seated candidiasis. Risk factors for IC include immunosuppression, critical illness, broad-spectrum antibiotic use, and skin barrier disruptions. Although C. albicans remains the most common species in IC, other species, such as C. tropicalis, C. glabrata, and C. auris, are becoming more prevalent. C. tropicalis is the most commonly isolated species in deep candida infections. Clinical presentations range from ecthyma gangrenosum-like lesions to ulcers, necrosis, and purpura fulminans. This review emphasizes the importance of a high index of suspicion for these infections, particularly in immunocompromised patients. Skin biopsy aids in timely diagnosis and treatment.