Chronic Fungal Skin Infection Treatment and Prevention Protection Status
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fungi candida albicans 3D


It doesn't matter where exactly I am educating, I see it everywhere: the vicious cycle of chronic intertrigo and/or candida infections (candidiasis) of the skin in the long-term care arena. Skin and soft tissue infections are the third most common infection in long-term care.

This ongoing problem is now receiving more attention due to state surveyors becoming certified in wound care. State surveyors will be up-to-date on skin and wound care management. Law firms are also advertising any type of skin breakdown as a negligence issue. Moisture-associated skin damage (MASD) and fungal skin infections are preventable. Fungal skin infections that lead to further skin breakdown equal poor quality of care.

I observe health care provider orders time and time again for antifungal powders/creams, numerous types of ointment/creams, and even nurses whipping up their own concoctions to treat fungal infections of the skin. Nurses should protect their license and remember that compounding is the pharmacist's job. I have also observed antifungal treatment orders in place for up to two years! Why? Recurring fungal rash/infections, due to gaps in nursing education. We as wound care clinicians must help to close these gaps.

Intertrigo and Yeast or Candida Skin Infections

Intertrigo is caused by moisture being trapped in skin folds. A dark warm area along with skin on skin friction will harbor bacteria, fungus and yeast. The symptoms typically include odor, itching and burning. Commonly affected areas include under the breasts, skin folds on the belly or thighs, the armpits and groin. However, it can happen anywhere there is moisture against the skin with a lack of air circulation.

Most people suffer from yeast (candida) skin infections in the perineal, buttock, and groin area. Some of the common symptoms of yeast infection are red, pimple-like bumps, with severe itchiness.

Skin Care 101: How to Prevent Fungal Skin Infections

  1. Cleanse skin with a pH balanced skin cleanser, no-rinse cleanser, or mild soap/water, then rinse.
  2. Dry the skin thoroughly. Soft cloth or pat dry technique.
  3. Incontinence care: Apply a skin sealant or barrier cream containing zinc oxide. All steps must be repeated after each incontinence episode. (Follow your policy and procedures for incontinence care. Check and change every 2 hours, etc.)
  4. Other locations: Moisturize with lotions containing lanolin or a petrolatum base. This will serve as a protective barrier.

Nurses and nursing assistants should be provided with ongoing skin care regimen education. While it may seem to be a simple skill or task, skin care regimen steps are not followed through on. So how can we help? When I go inside facilities, I recommend the Wound Nurse, Charge Nurse, or Unit Manager follow all nursing staff periodically to check skills with skin care, brief changing, and offloading techniques. Nurses must apply creams and ointments that cannot be kept at the bedside. This also shows monitoring of the affected skin sites. Prevention measures should be in place for fungal skin infections, especially for the obese patient. Bed linens, paper towels, or dressings should not be used to separate skin folds. There are many moisture-wicking fabrics impregnated with antimicrobial properties available for skin moisture management.

Black JM, Gray M, Bliss DZ, et al. MASD part 2: incontinence-associated dermatitis and intertriginous dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2011 Jul-Aug;38(4):359-70; quiz 371-2.
Gould D. Diagnosis, prevention and treatment of fungal infections. Nurs Stand. 2011 Apr 20-26;25(33):38-47; quiz 48.
Lowe JR. Skin Integrity in Critically Ill Obese Patients. Crit Care Nurs Clin North Am. 2009 Sep;21(3):311–v.
Mouton CP, Bazaldua OV, Pierce B, Espino DV. Common infections in older adults. Am Fam Physician. 2001 Jan 15;63(2):257-68.

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.


Hi Cheryl,
I do a lot of leg wraps for venous insufficiency, edema and stasis dermatitis. Wraps are being changed 2 times a week. Sometimes the patients have excess drainage and we see the rash or denuded areas. I have started using Zeasorb plus the moisturizer. it seems to work. Sometimes I will use if prophylactically for those who have excess drainage.

The author's focus is identifying a chronic in-patient issue, and it is also something we see daily in our outpatient wound clinic. Many people will use home remedies from corn starch to kerosene to treat the rashes. Since obesity is such an epidemic in our country, I am sure this is prevalent throughout most communities. I do education at our mall-based Health Resource Center for community members, and I would love to see more emphasis placed on this issue for patient safety and comfort.

I am an Occupational Therapist / Educator and have worked in Residential Care sites in Vancouver Canada for a long time. Another consideration is microclimate management of the bed surface that our residents are on for more than 12-20 hours per day. Low air loss mattress surfaces or overlays often work quite well to keep resident's skin dry.

I work in long term care and yes fungal skin infections is a problem. what I do for prevention is have the area cleaned and dried every morning and apply a non scented deodorant. at first this was not received well. why do you use deodorant in the axillae? to decrease odor and keep dry. this works well. I have patients who have not had yeast in 2 years!!!

Thank you for that short but effective refresher about MASD. Your blogs are the best!!

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