By Gary M. White, MD
Congenital candidiasis represents infection of the fetus by Candida which occurred in utero via ascending infection through the maternal vagina through intact membranes. In contrast, neonatal candidiasis results from passage of the fetus through an infected birth canal.
A diffuse erythematous maculopapular eruption within the first 12 hours of life that evolves into vesicles and pustules and later desquamation is characteristic. The palms and soles are almost always affected. The mom often has had a bout of vulvovaginitis during pregnancy. Respiratory distress, hepatosplenomegaly and signs of sepsis may occur. The nail plates may be affected.
It is said that the presence of white microabscesses on the surface of placenta and umbilical cord is pathognomonic. A KOH exam of the skin verifies the diagnosis.
Oral and topical antifungal therapy should be initiated. Occasional there may be a need for parental therapy (e.g. fluconazole) if systemic involvement (e.g. Candidal pneumonia) is suspected. If disseminated disease does occur, amphotericin B may be needed.
An infant was given topical 2% ketaconazole cream twice daily along with fluconazole 6 mg/kg intravenously once daily for 3 days as there was leucocytosis. Once improvement was obtained, the infant was switched to oral fluconazole (6 mg/kg/week) and topical ketoconazole. Healing was achieved. Congenital Candidiasis. Indian Dermatol Online J 2014;5, Suppl S1:44-7