Yeast Infection On The Face Causes

Overview

Yeast infection is a popular name for a condition called “candidiasis.” it is most commonly caused by a fungus called Candida albicans, though other species of the Candida genus can cause this disease, like Candida auris.¹ It is a common condition that can affect many areas of the body, as this type of yeast naturally occurs in our bodies: the mouth (often called “thrush” in this case), skin, fingernails or toenails, and the genitalia are the most affected sites of yeast infections.¹ In rare cases, candidiasis can lead to serious complications if the infection spreads into the bloodstream (sepsis), affecting the lungs, kidneys and even the brain.¹ Let’s understand more about this fungus and what effects it has on the face.

Causes

Candida albicans is one of the many species under the Candida genus that can cause candidiasis, being responsible for most cases of the disease.² Other species include C. glabrata, C. guillermondii, C. kruesi, C. lusitaniae, C. parapsilosis, C. pseudotropicalis, C. stellatoidea, C. tropicalis, and C. auris. In most cases, infections are mild and don’t require culture testing to identify the species; however, in more serious cases with systemic involvement, identifying the species is essential when determining the best course of treatment, including medication.²

Most adults already have the Candida fungus in their bodies: it exists as a commensal organism - meaning that while it obtains benefits by living inside our bodies, it does not bring harm to us in normal circumstances.³ However, the extreme proliferation of the fungus can happen if there is an imbalance in the local microbiome (such as after the use of broad-spectrum antibiotics) or if the patient’s immune system is not competent enough to keep the fungus under control.⁵ There are certain risk factors associated with candidiasis:²

• Age: Young children and the elderly are more at risk of developing candidiasis².
• Malnourishment²
• Metabolic disease²
• Other concurrent infections²
• Salivary gland hypofunction (which leads to lesser salivary flow and dry mouth/xerostomia)²
• Radiotherapy²
• Long-term corticosteroid therapy or chemotherapy²
• Patients with compromised immune systems: cancer patients, HIV-positive patients, patients who have received an organ transplant, and those who are recovering from surgery, among others.²
• Endocrine conditions: diabetes mellitus and Cushing syndrome are risk factors to candidiasis⁴
• Environmental factors: warm and hot climates, wearing tight and occlusive clothing, use of dentures, and poor hygiene can lead to candidiasis⁴
• Broad spectrum antibiotic therapy: as broad-spectrum antibiotics kill all bacteria (including the ones that are beneficial to us, like gut microbiota), it allows the Candida fungus to proliferate unchecked and take over⁵

Signs and symptoms

On the face, oral candidiasis (thrush) is the most common manifestation of yeast infections: in children, it can happen even in otherwise healthy children (as their immune systems are still developing), but in adults, thrush can point to immunodeficiency like HIV, cancer, or diabetes⁵. Thrush can also happen in patients who use dentures or have otherwise poor hygiene⁴. Signs of oral candidiasis include:

• White, plaque-like lesions: common sites are the tongue and buccal mucosa (sides of the mouth/inside of the cheeks).⁵ White lesions of the mouth can be divided into pseudomembranous candidiasis (the form known as thrush) and hyperplastic candidiasis.⁶
  • Acute pseudomembranous candidiasis is often found in newborns or immunocompromised individuals.² It consists of white plaques that can be easily scraped.²
  • Hyperplastic candidiasis (or chronic hyperplastic candidiasis) is a form of the disease that causes white plaques that cannot be scraped to appear.² It is more common in those who smoke or chew tobacco and can often be found in the sides of the tongue or the buccal mucosa.²

• Red lesions are often more challenging to diagnose.² They can present as ulcers or redness of the mouth and a burning sensation.² Types of red (erythematous) lesions include acute and chronic atrophic candidiasis, median rhomboid glossitis, angular cheilitis, and linear gingival erythema.⁶
  • Acute atrophic candidiasis is often caused by the use of antibiotics, causing a reddish appearance of the mucosa accompanied by pain or a burning sensation.² Meanwhile, its chronic counterpart is more common in those who have dentures and can often be asymptomatic, with a red colouration of the mucosa in areas touched by the denture, and hygiene is often poor in these patients (an additional risk factor to candidiasis).²
  • Angular cheilitis is a variety of candidiasis that affects the mouth corners, causing tenderness and redness of the area (with or without pain)². Patients of older age are more at risk, especially after spending extensive periods of time with their mouths open (after long visits to the dentist, for example).² Habits like thumb sucking or excessively licking the lips can present as risk factors for angular cheilitis.⁵
  • Median rhomboid glossitis is a condition that causes loss of the lingual papillae and redness of the dorsum of the tongue, often being asymptomatic.⁷
  • Linear gingival erythema consists of a red band across the gingiva, either locally or generalised, and it is more often found in patients with HIV; however, poor oral hygiene and herpes virus infection are other possible causes for this presentation of candidiasis.⁶

Aside from oral manifestations, chronic mucocutaneous candidiasis often affects the nose or forehead⁵. This form causes red lesions filled with pus and thick crusts, resembling psoriasis.⁵

Candidal intertrigo is another form that can affect the head and neck area: this form of candidiasis affects areas of skin folds.⁵ In infants, it frequently occurs in areas where diapers touch (known as a diaper rash).⁵ However, it can affect any areas in which skin rubs against bare skin, like under the arms, under the breasts, or behind the ears. It usually presents as a bright red rash, with or without pustules, that itches or burns.⁵

Diagnosis

The diagnosis of candidiasis is often clinical, and a physician or a dentist (depending on the area affected) should examine the area affected: either a rash, ulcer or plaque lesion, with or without a scrapable white substance present, is characteristic of candidiasis.⁵ A compatible lesion with a medical history that points to candidiasis is more than enough to diagnose a patient.⁶

If necessary, a health professional can obtain a sample to test for candidiasis: in the case of oral candidiasis, saliva samples, oral smear, or a culture test can be useful to confirm the diagnosis, though not always necessary.⁶ In the case of drug-resistant candidiasis, culture tests can determine what type of Candida fungus is responsible for the infection and which drug would be more efficient in treating it.² In most cases, a physician might prescribe an antifungal medication before doing tests as a therapeutic trial can not only prove that it is candidiasis but solve the problem all at once.²

In rare cases, a cytology smear or a biopsy will be necessary.⁶ A biopsy might be necessary if the lesion is similar to other conditions like leukoplakia, lichen planus and syphilis, in order to eliminate all possibilities.⁶

Management and treatment

Treatment of yeast infections is done with antifungal medication.⁶ For oral candidiasis, a nystatin suspension is often prescribed, and if the infection affects the mouth corners or areas surrounding the lips, creams containing nystatin can also be prescribed⁴. Similarly, for candidal intertrigo, topical antifungal creams can be used, and they are often prescribed with corticosteroids as well.⁴ Severe infections, or those that have not responded well to local treatment (creams or suspension), can be treated with systemic medication in the form of pills: fluconazole and itraconazole are two commonly prescribed drugs to treat candidiasis².

Most importantly, treating candidiasis means removing the risk factors whenever possible.⁶ A few tips are:

• Better hygiene: brushing your teeth and flossing correctly, with adequate frequency, can help prevent candidiasis, among many other ailments.⁶ Likewise, skin hygiene is just as important: properly drying yourself and using antiperspirants are important steps in preventing candidal intertrigo.⁴
• Adequate care of dentures: aside from dental hygiene, cleaning dentures properly can greatly reduce the risk of oral candidiasis; it is highly recommended to take off the dentures before sleep and to soak them in white vinegar or diluted hypochlorite (bleach) solution or chlorhexidine gluconate (2% suspension) every night for at least 30 minutes.⁶ Making sure the dentures fit you adequately is also important in preventing forms like actinic cheilitis.⁶
• Combat xerostomia (dry mouth): drinking more water is always important for many other reasons besides preventing candidiasis.⁶ However, some medications (like furosemide) can cause xerostomia, as well as autoimmune conditions like Sjögren syndrome: artificial saliva or changing medications are options to be discussed with your doctor.
• Keep your health in check: more than 90% of patients who are HIV-positive and are not undergoing antiretroviral treatment develop candidiasis⁴. As many chronic health conditions are risk factors for this disease, taking proper care of your health is important in avoiding candidiasis.

FAQ

Who is more at risk of developing yeast infections on the face?

Children and elders, those who have compromised immune systems (HIV-positive, cancer patients), those who have endocrine conditions (like diabetes), patients who have dentures, patients who have undergone radiotherapy or chemotherapy, and those who have undergone recent antibiotic treatment are more likely to develop candidiasis.²

How can I prevent yeast infections?

Maintaining good hygiene, taking care of dentures, avoiding dry mouth, and keeping chronic health conditions like HIV, cancer, diabetes and autoimmune diseases in check are good ways to prevent candidiasis.⁶

Summary

Yeast infections on the face are caused by fungi of the Candida genus, most commonly Candida albicans. This fungus is naturally present in our bodies, and when our immune systems are weak, or there are no competing bacteria to keep their proliferation in check, this fungus starts to proliferate and take over locally or, in severe cases, systemically. Common signs and symptoms include white plaque-like lesions that can be easily scraped, affecting the tongue and buccal mucosa, or red, painful rashes affecting the skin or mouth corners. Diagnosis is often clinical, and treatment includes topical creams or suspensions of antifungal medication, but in severe cases or when the infection persists after treatment, systemic drugs can be prescribed. Prevention of candidiasis involves good oral and physical hygiene, taking adequate care of dentures, avoiding dry mouth, and keeping chronic illnesses under control.