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Candidal intertrigo introduced, often involving the skin smooth and direct friction between the parts, such as the armpits, under breasts, groin, perianal, Tungou, perineum, penis, etc. umbilical fossa. Lesions begin as erythema, papules or vesicles, fused into a clear edge after the expansion of the erythema. Scaling or blisters formed after rupture of erosion surface, and sometimes a small amount of exudate. Chapped and occasional pain. Peripheral lesions may have scattered papules, vesicles or pustules, was the satellite-like distribution. Some damage was drying pimples or pimple-like pustules like. Conscious patients with itching. Candida causes widespin nature and the normal oral, gastrointestinal, respiratory tract, vagina and skin. Under normal circumstances, Candida is in symbiosis with the human body does not cause the disease, only in pathogenic only under certain conditions, so called opportunistic pathogen. Pathogenic bacteria can invade the body depends upon the number of pathogenic bacteria, virulence organism invasion pathway and resistance to the pathogen. When the patient has diabetes, cancer, chronic wasting disease and long-term use of broad spectrum antibiotics, corticosteroids and immunosuppressive agents as a result of body resistance drops, are prone to infection. Can also be due to the long catheters, intubation, organ transplantation, radiotherapy, chemotherapy and disease. Most of the disease are endogenous infection, a small number of exogenous


infection. Clinical manifestations of Candida intertrigo, and obesity more common in children who hyperhidrosis, rash occur in the groin, groove Tungou, axillary folds and the lower parts of the breast. Locally bounded clear, moist erosion surface, basal flushing, with the edge of the collar-like scales. Peripheral often scattered red papules, herpes, or pustules. Treatment (a) for topical treatment of skin and mucosal candidiasis. 1. Nystatin ointment. Camphor 2.1% sulfur 10% 5% calamine lotion lOOml plus nystatin 100 million u. 3. Nystatin vaginal suppositories, each suppository containing nystatin 5 million to 10 million u. 4. Topical miconazole cream 2 times a day. (B) systemic treatment 1. Nystatin for alimentary tract candidiasis. 2. Poly-formaldehyde inhalation nystatin for bronchopulmonary candidiasis. 3. Ketoconazole. 4. Intravenous amphotericin B and 5-Fo have synergistic effect. 5. Fluconazole. Oral or intravenous injection. Should be used for oropharyngeal candidiasis. 6. Itraconazole. Should be used for oral candidiasis, vaginal candidiasis, systemic candidiasis.
Candida albicans disease diagnostic laboratory diagnostic methods, is currently considered the most reliable medium in the formation of thick-walled spores of corn, the most simple way is to direct microscopy specimens. Dentists in the pseudomembrane often take oral mucosa, epithelial shedding, and other samples scab shell, placed in a slide, dropping 10% a few drops of potassium hydroxide solution, covered with coverslip, heated to dissolve the skin with Weihuo, Then immediately the microscope, hyphae or spores are found false, can be recognized as fungal infection, but also must develop in order to diagnose Candida albicans. Type of acute pseudomembranous candidiasis stomatitis should be stomatitis and acute cocci (membranous stomatitis) identification. Membranous stomatitis by Staphylococcus aureus, hemolytic streptococcus, Streptococcus pneumoniae and other bacterial infections caused predispose children and the elderly, can occur in any part of the oral mucosa, congestion and edema was significantly affected areas, a large number of fibrinogen from vascular leakage, condensation into a white or grayish yellow pseudomembrane, smooth surface, slightly out of mucosal surface. Pseudomembrane easily wipe away, erosion surface and are left bleeding. Regional lymph nodes may be associated with systemic reactions. Smear or bacterial culture to identify the main pathogens. Incentive 1. Pathogen Candida albicans and type of toxicity is a budding oval yeast-like fungi in tissues and secretions in the medium can produce pseudohyphae of the Gram-positive bacteria 2 ~ 3 m 4 ~ 6 m extended budding cells, mimicking named pseudohyphal mycelium. Pseudohyphal formation in the nodules budding spores, and sometimes yeast in the end is not the formation of chlamydospore formation of true hyphae. Candida depends on the strength of toxic metabolites of toxic substances in the digestive tract or vaginal yeast-type Candida parasite, there is no pathogenicity, and when it is only when development for the pathogenic filamentous form. Toxins have the equivalent of Candida albicans phospholipase-A virus activity of type suspension of the bacteria can be lethal intravenous injection of animals, so the toxicity of pathogenic bacteria and type of force is closely related with the disease in the saliva in healthy carriers with bacteria is less than 200/ml, it is generally microscopic examination can not directly see the smear of pathogens in check. Candida albicans to oral epithelial strong adhesion, which is its pathogenic role in the "starting point" of this epithelial cell adhesion depend on the surface of the protein part of the glycosides of mannose as cell surface receptors and play its adhesion, it can damage the protein or glycosides similar structures which can inhibit the adhesion of the occurrence of new treatments on offer to explore a way. 2. Host defense function of a human serum containing anti-fungal components (serum factor) can inhibit the growth of Candida albicans in the newborn baby (1 ~ 3 months) than the parent body, but there is a low 6 to 12 months to reach adult levels before it is six months old, especially infants less than a month most likely to suffer from oral mucosal candidiasis also the body's neutrophils monocytes and eosinophils also have to digest and destroy the function of Candida albicans 3. drugs and other factors affect the body's defense corticosteroid (SH) the misuse of a common cause of Candida infections can be reduced reticulocyte SH endothelial function of the system to reduce antibody formation to reduce inflammation; the other hand, can increase the SH increase fungal activity the toxicity of immunosuppressive fungal and anti-metabolic drugs which have caused the performance of the spof fungal propagation conditions can cause flora of broad spectrum antibiotics (such as oral tetracycline 20 days or more may have 2% to 3% of the patients flora ) destroy the body in the digestive tract of the balance of bacteria and fungi have anti-fungal effect can inhibit some Gram-negative bacteria and are able to synthesize vitamin B family of bacterial growth; vitamin B group shortages also can lead to cells by oxidation of the coenzyme reduced resistance and thus inhibiting the organization is conducive to fungal growth 4. host disease, congenital systemic immune function (such as thymic atrophy) to accept a large number of X-ray irradiation than the non- -globulin and immune function in hyperlipidemia reticuloendothelial system diseases such as leukemia, lymphoma, Hodgkin's disease complicated by candidiasis and so easy to serum iron metabolism is considered to be one of the causes candidiasis which may be caused by iron deficiency and abnormal enzyme system of the body (iron is related to the process of cellular redox enzymes such as cytochrome peroxidase part) caused by defects in immune function in endocrine dysfunction such as hypothyroidism, pituitary dysfunction Aidi Sen disease caught diabetic patients susceptible to candidiasis skin surface pH, low sugar content conducive to higher growth and invasion of Candida albicans, others argue that the keratinized layer of the epidermis of patients with diabetes lower levels of fatty acids inhibit the ability of fungi weaker severe immunodeficiency disease is often associated with oral candidiasis 5. other factors, environmental factors and working conditions were associated with the pathogenesis of C. albicans, such as high temperature and humid conditions in the work of skin candidiasis prone to chronic local irritation, such as dentures and other orthodontic devices can be excessive smoking as factors of Candida albicans infection is contagious pathogenic important factor in the baby room in that house, can be derived from the maternal vaginal bacteria to newborn children because of maternal vaginal thrush occurs within 20 days of neonatal infections of skin candidiasis are the most complications, if not addressed, could spto the throat , digestive tract and respiratory tract, and fungal sepsis, endocarditis, meningitis and other serious complications. A local drug treatment (1) 2% to 4% sodium bicarbonate (baking soda) solution of the drug treatment of infant thrush Department of commonly used drugs. For breast-feeding before and after washing the mouth, to eliminate the residual acid can break down the curd, or sugar, the mouth into an alkaline environment, can prevent the growth and reproduction of Candida albicans. No other drugs in children with mild, lesions in 2 to 3 days to disappear, but the need to continue medication for several days to prevent recurrence. Can also be washed before and after the drug in breast-feeding nipple to prevent cross-infection or repeated infection. (2) crystal violet aqueous solution of gentian violet solution in the concentration of 1:10 million, still inhibit the growth of Candida. Oral mucosa in order to use the 1 / 2000 (0.05%) concentration is appropriate, 3 times daily application may be to treat infants with thrush and angular cheilitis. But the drugs staining observed damage should not change. 1% gentian violet solution of commercially available alcohol, because of irritating a large, infants and young children should not be directly used for the oral mucosa, but can be used for skin lesions. (3) chlorhexidine chlorhexidine have anti-fungal activity, the choice of 0.2% or 1% gel solution, partial coating, wash or rinse can also be compatible with the nystatin ointment or cream into which they could join amount to triamcinolone acetonide for the treatment of angular cheilitis, mouth care of teeth go far (you can wear a cream applied to the base entrance in the tissue surface). Chlorhexidine solution and sodium bicarbonate solution to turn toilet, can eliminate the synergistic pathogen Candida albicans - Gram-negative bacteria. Antifungal therapy (1) nystatin (mycostatin) the drug is four vinyl antibiotics, 1mg equivalent 2000U, appropriate for low-temperature storage. Can not easily be absorbed in the intestine, it is used for treatment of skin and mucous membrane and gastrointestinal Candida albicans infections. Local 5 million to 10 million available U / ml of water suspension coating, once every 2 to 3 hours, after the coating can be swallowed. Gargle mouthwash can also be used, or made into tablets, emulsions and so on. Children (1 to 2 years) oral 100,000 U / times, 3 times a day; adult oral 500,000 ~ 1,000,000 U / times, 3 times a day. The inhibitory effect of this drug may be released by destroying the cell membrane potassium, which led to suspension of cells lose their vitality glycogenolysis. Oral minimal side effects, occasionally cause nausea, diarrhea, or loss of appetite are. Course of 7 to 10 days. (2), miconazole (miconazole): This drug is a synthetic broad-spectrum antifungal, miconazole nitrate topical use of domestic goods Mingdakening. In addition to anti-fungal, this drug still has the anti-Gram-positive bacteria effect. Powder can be used in oral mucosa, cream for glossitis and angular stomatitis, treatment is usually 10 days. (3), clotrimazole (clotrimazole) for the synthesis of broad-spectrum antifungal agent, toxic, rapidly absorbed after oral administration, 4 to 5 hours to reach maximum concentration in blood, and into the mucosa and saliva. The drug can affect the synthesis of ergosterol, so that fungal cell membrane defect, the contents overflow caused by fungal death. Adult daily oral 3 times 0.5g, at doses up to 3g. The main side effects of this drug for the gut reaction; long-term use can affect liver function, causing neutropenia, it is now more use of local agents. (4), ketoconazole (ketoconazole) is recommended after 70 years abroad, anti-Candida albicans drug, can inhibit the fungal cell membrane DNA and RNA, rapid efficacy, oral absorption peak after 2 hours, through the blood circulation to the lesion. Once daily oral dose of 200mg, 2 ~ 4 course Monday. Can be used with other local antifungal combination, better. For the skin, gastrointestinal tract and other oral outside the fungal disease has significant effect, present in a foreign country has replaced amphotericin. The drug is not acid drugs with anticholinergic drugs or the same clothes, so as not to affect the absorption. Comprehensive treatment of mucosal congestion and edema significantly, tongue red, breath, urine, constipation or stomach heat and inflammation Firelight dampness on the witness, it can take "stomatitis granules" (see chapter on herpes simplex). In addition to use of antifungal agents, the body weak, there is immune deficiency disease or related diseases and chronic systemic Candida infection in patients, often need to be complemented enhance immunity of the comprehensive treatment measures, such as injection of transfer factor, thymosin , lipopolysaccharide, etc., to add iron, vitamin A; and multiple small blood transfusions. The treatment of oral candidiasis time should be extended, generally a period of 14 days, lesions prone to cause recurrence of premature withdrawal. And hypertrophic (growth type) of treatment should be longer, there are reports of up to 3 to 4 months, the effect is not significant Candida leukoplakia, should try to consider surgery. To avoid the delivery room to prevent cross-infection, childbirth should pay attention to the perineum, the birth canal, birth attendants hands and utensils of all births. Often with warm water to wash the baby wipe the mouth, breast-feeding utensils sterilized by boiling, and should be kept dry nipples in breastfeeding mothers, the best of 1 / 5000 hydrochloride chlorhexidine solution to clean, and then cold water Shi Jing. Child protection in the winter should be dry and cracked lips, tongue sucking lips licking correct bad habits. Long-term use of antibiotics and immunosuppressive agents in patients suffering from chronic wasting disease, or patients should be alert to the occurrence of Candida albicans infections, with particular attention to easily overlooked deep (visceral) Candida albicans complications. Etiology 25% ~ 50% of the healthy mouth, vagina, gastrointestinal tract can be with Candida, but not incidence; not pathogenic Candida, under certain conditions, can be transformed into pathogenic, so it is called rosary-like bacteria as opportunistic pathogens. Snow and mouth disease in young children, dental stomatitis care, angular stomatitis, candidal leukoplakia and chronic mucocutaneous candidiasis patients, the detection rate of C. albicans were 84%, 69%, 77%, 84% and 100%. 1. Pathogen Candida albicans toxicity and a type of oval budding yeast-like fungi in the culture medium, tissue, and secretions can produce pseudohyphae, the bacteria were Gram-positive, 2 ~ 3 m 4 ~ 6 m, mimicking the extended hyphae budding cells, pseudohyphae named, pseudohyphal formation in the nodules budding spores, sometimes in the end of the formation of thick-walled spores, yeast and true hyphae are not formed. Candida strength of toxicity, depending on the metabolites of toxic substances. Parasitic in the digestive tract or vaginal yeast-type Candida is not pathogenic, and when it is developed for the filamentous form, the only pathogenicity. Toxins have the equivalent of Candida albicans phospholipase-A virus-type activity to the suspension of the bacteria can be lethal intravenous injection of animals. Therefore, the toxicity of pathogenic bacteria and type of force is closely related with the disease. In the healthy carrier in the bacterial content of saliva is lower than 200/ml, therefore, generally microscopic examination can not directly see the smear of pathogens in check. Candida albicans to oral epithelial strong adhesion, which is its pathogenic role of "footing", such adhesion of epithelial cells depend on the surface of the protein part of the glycosides of mannose as a cell surface receptor Adhesion to play its role, therefore, can damage proteins glycosides or similar structures could inhibit the occurrence of adhesion, which is exploring new ways to provide a therapeutic drug. 2. Host defense function of a human serum containing anti-fungal components (serum factor), can inhibit the growth of Candida albicans, in the newborn baby (1 ~ 3 months) the body to exist, but lower than the mother, 6 12 months to reach adult levels. Therefore, before six months old, especially infants less than a month, most likely to suffer from oral candidiasis. In addition, the body's neutrophils, monocytes and eosinophils, but also digest and kill Candida albicans functions. 3. Drugs and other factors affect the body's defense corticosteroid (SH) of the abuse, often caused by Candida infection, SH can weaken the function of reticular endothelial system, reduce inflammation, reduce antibody formation; the other hand, SH and fungal activity can increase capacity and enhance the toxicity of fungi, immunosuppressive agents, and anti-metabolism drugs have the performance, resulting in the spof fungal propagation conditions. Broad-spectrum antibiotics can cause flora (such as oral tetracycline for 20 days or more, may have 2% to 3% of the patients flora), damage the body in the digestive tract of the balance of bacteria and fungi, can inhibit the antifungal effect with a Some gram-negative bacteria can synthesize vitamin B group and bacterial growth; a lack of vitamin B family, can also lead to inhibition of cell oxidation of coenzyme, the organization reduced resistance, which is conducive to fungal growth. 4. Host disease, congenital systemic immune function (such as thymic atrophy), accept the relatively large number of X-ray irradiation, no -globulin anemia, and affect the immune function of the reticuloendothelial system diseases such as lymphoma, Hodgkin's disease, leukemia, etc., are easily complicated by candidiasis. Serum iron metabolism is considered to be one of the causes candidiasis, which may be caused by iron deficiency and abnormal enzyme system of the body (iron oxide reduction process is related to cellular enzymes such as peroxidase, cytochrome component) and the immune function defects. Endocrine dysfunction, such as hypothyroidism, Aidi Sen disease, pituitary dysfunction who are susceptible to candidiasis. Patients with diabetes lower surface of the skin pH value, the higher sugar content, which will help the growth and invasion of Candida albicans. Some people think that the keratinized layer of the epidermis of patients with diabetes lower levels of fatty acids, inhibit the ability of fungi weaker. Severe immune deficiency disease, often associated with oral candidiasis. 5. Other factors, environmental factors and working conditions are related to the pathogenesis of C. albicans, such as high temperature and humidity conditions in the work of skin prone to candidiasis. Chronic local irritation, such as dentures, orthodontic devices, excessive smoking, can be factors of Candida albicans infection. Contagious, is also an important factor in disease. In the maternity hospital nursery, the pathogen can be derived from the mother's vagina, the occurrence of thrush newborn child. Because maternal vaginal infection, 20 days of neonatal cutaneous candidiasis is also the most. Classification and clinical manifestations of oral candidiasis lesions can be divided into the main schedule: Candida stomatitis, Candida cheilitis and angular cheilitis, chronic mucocutaneous candidiasis. And Candida albicans infection of oral disease include: lichen planus, hairy tongue and median rhomboid glossitis. 1. Candidal stomatitis (candidal stomatitis) (1) acute pseudomembranous type (snow and mouth disease): acute pseudomembranous candidiasis stomatitis type, can occur at any age, but the most common newborn babies, the incidence 4%, also known as thrush or snow-mouth disease in newborns. Newborn thrush more in the 2 to 8 days after birth occurred, a good site for the cheek, tongue, soft palate and lip, damage to mucosal congestion zone, with scattered small color white as snow, soft spots, such as the size of the needle cap, "born in the mouth white crumbs over the tongue "(" ulcer Medical Filmography "); soon merging to white or blue and white wool-like plaques, and may continue to expand the spof severe tonsil, throat, gums, resulting in:" mouthful of students are white flakes and even between the stacks of swollen throat "(" surgical authentic "). Early mucosal congestion is obvious, it was bright red and white contrast. The old lesions decreased mucosal congestion, white with a yellow patch. Patch attached is not very close, a little harder to wipe off, exposing the red face and mild bleeding mucosal erosion. Children with irritability, crying, feeding difficulties, and sometimes a mild fever, systemic reactions are relatively light; but a few cases, it may spto the esophagus and bronchi, cause candida esophagitis or pulmonary candidiasis. Children can also be complicated by a small number of patients with generalized skin candidiasis, chronic mucocutaneous candidiasis. (2) acute atrophy: acute atrophic candidiasis stomatitis more common in adults, often due to long-term application of broad-spectrum antibiotics, walls have the original and most patients suffering from wasting disease, such as leukemia, malnutrition, endocrine disorders, After chemotherapy and so on. Some skin diseases such as systemic lupus erythematosus, psoriasis, pemphigus, etc., in the large-scale application of penicillin and streptomycin in the process, may also occur Candida stomatitis, therefore, this type is also known as oral antibiotics inflammation. It should be noted that this adult acute candidiasis may have pseudomembranous stomatitis and angular cheilitis associated with, but sometimes mainly for mucosal erosions and tongue, nipple congestion was mass atrophy, thickening of the surrounding fur. First, patients often have unusual taste or loss of taste, dry mouth, mucous membrane burning. (3) chronic hypertrophic: the proliferation of this type or call type Candida stomatitis, seen in the buccal mucosa, tongue, and palate. Deep into the hyphae within the mucosa or the skin, causing parakeratosis, acanthosis, epithelial hyperplasia, lamina micro-abscess formation and inflammatory cell infiltration of the nipple, and the surface of the pseudomembrane and closely attached to the cortex, not easy to peel. Histological examination, can be seen with mild to moderate dysplasia, one that is higher than candidal leukoplakia malignant transformation rate of 4%, especially the elderly patients should be alert for early biopsy to confirm the diagnosis. (See the section of oral leukoplakia) lesions of this type of buccal mucosa, often symmetrically located in the altercation inside the triangle, or granular nodular hyperplasia, or close to fixing the white skin patches, similar to the general leukoplakia. Dental care palate lesion stomatitis can be developed from the mucosa showed papillary hyperplasia; tongue, lesions, can be expressed as the proliferation of filiform papillae, the color gray, called hairy tongue, the tongue is also part of this hair type ( See the Department of tongue disease). Hypertrophic Candida stomatitis, chronic mucocutaneous candidiasis as a component of disease symptoms, but also seen in immune deficiency syndrome and endocrine dysfunction in patients. (4) chronic atrophic type: This type of dental care, also known as stomatitis, damage parts of the maxillary denture palate often in with the side of the palate, gingival mucosa, more common in female patients (maxillary denture was worn by women statistics incidence rate of 1 / 4 , while the male is 1 / 10). Mucosal edema was bright red, or yellow or white cord-like speckled pseudomembrane. 90% of patients with plaque or pseudomembrane, you can check see Candida albicans. Candida cheilitis or angular stomatitis with 80% of the patients care dental stomatitis, on the contrary, this type of disease can often occur in isolation, may not have concurrent damage to the lips and mouth. Dental care is also often associated with stomatitis papillary hyperplasia of the palate in the same place, in considering the surgery, before antifungal treatment can significantly reduce the degree of proliferation, narrowing the scope of need for surgery. Dental care on the attachment of pathogenic fungi is the main reason, such as the commonly used 2% chlorhexidine or nystatin washing, can inhibit the fungus. There is a flexible silicon rubber base dental care seems more likely to stay in the adsorption of fungi, and thus care dental stomatitis occurs the chance of more. Mandibular denture stomatitis caused by the fungus is rare, this may be due to the negative pressure in the maxillary denture adsorption force, the antibodies in saliva to be arranged from this area, and basal and mucous membrane with both wide and close, a large number of pathogenic the sake of fungi to be stranded. 2. Candidal cheilitis (candidal cheilitis) Candida infection of the disease is chronic cheilitis, mainly in go further (50 years) patients. Generally occurs in the lower lip, which can have Candida stomatitis or angular cheilitis. Gansen will be divided into two types of the disease, erosive in the copies in the lower lip vermilion bright red long-standing erosion surface, there was hyperkeratosis around the phenomenon of surface scaling, so easily confused with discoid lupus erythematosus lesions also similar to the light cheilitis. Particulate who showed swollen lower lip, vermilion skin junction is often scattered in a prominent small particles, very similar to the glandular cheilitis. Therefore, Candida cheilitis should be scraping the edge of the scales and the erosion of small granular tissue, microscopic examination fungi, such as the number found in blastospores and pseudohyphae, and proof of Candida albicans by culture only when confirmed. 3. Candidiasis angular cheilitis (candidal angular cheilitis) is characteristic of the disease often suffer from both sides, mouth area of the skin and mucous membranes to chapped, close to the skin and mucous membrane congestion, chapped erosion and exudation often at, or Results a thin crust, when the pain or haemorrhagic mouth. Such wet white fungal angular cheilitis is characterized by erosion, should vitamin B2 deficiency or bacterial angular cheilitis difference, while the former is complicated by glossitis, cheilitis, scrotum dermatitis or vulvitis, which occurred in the side of the mouth more than a single bacterial culture was positive (in Streptococcus based); and candidiasis angular cheilitis occurred in children, frail patients and blood diseases. The angular stomatitis and more elderly patients with reduced occlusal vertical dimension is related to skin and mouth area was grooved collapsed, leading to overflow of saliva from the mouth into the groove, it often has wet state, is conducive to mold growth and reproduction. There are reports of 150 cases who wear dentures, 75 patients had angular cheilitis, its causes and some shorter than the vertical distance of systemic factors, local stimulation with the denture, denture ulcer infection is also closely related. Children allowed to dry in the cold winter, chapped lips because of the angular cheilitis secondary to Candida infection are more common. 4. Chronic mucocutaneous candidiasis (chronic muco-derma candidiasis) is a special type of Candida albicans infections, lesions involving the oral mucosa, skin and nail bed. More from the childhood disease, the course for several years to several decades, often accompanied by endocrine, or immune dysfunction, immune dysfunction, so this disease is actually a syndrome expression. Lehner this group of diseases is divided into the following types of several causes: (1) type of multiple endocrine disease: before and after the onset of puberty often, early stage or performance of hypoparathyroidism and chronic adrenal insufficiency cornea - conjunctivitis, However, Candida stomatitis may be the earliest representation of the disease. (2) T lymphocyte deficiency type: The disease can be found in the high -globulin hyperlipidemia and malignant lymphoreticular tumors. (3) chronic mucocutaneous candidiasis family: the type found in children, but also after the age of onset in 35 adults (delayed), are associated with iron absorption, metabolic abnormalities, may be due to iron deficiency when the white beads reducing bacteria inhibitor, resulting in the propagation and invasion of pathogenic bacteria. Various types of chronic mucocutaneous candidiasis, the first performance of the symptoms are often chronic unhealed or recurrent thrush and angular cheilitis; then occur in the head and face and extremities like scaling erythematous rash, deck thickness, can also occur Alopecia and the forehead, nose cutaneous horn-like damage.


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