[Congenital cutaneous candidiasis: a case with review of the literature]

The clinical features of CCC are stereotyped. Twenty-two cases have been found in the literature. Skin lesions are present at birth (12/22) or within the first twelve hours of life (7/22) and sometimes later, up to the sixth day of life. Maculopapular lesions are the first to appear, followed by the more typical vesiculopustular rash and secondary desquamation. Involvement of the upper half of the body is frequent. Interestingly, palm and sole pustules are almost constant. Oral, periungueal and conjunctival lesions are rare. In most cases, healing occurs within ten days of topical treatment using either nystatin or imidazole derivatives. Rarely (2/22), systemic candidiasis may be associated and may progress to death because of lung or meningeal involvement. Differential diagnosis includes post-natal acquired candidiasis, infectious pustulosis-impetigo, herpes, varicella-, and syphilis. In the authors' experience, pustular erythema toxicum is the most difficult diagnosis to rule out and the value of the direct smear must be emphasized. The clinical picture of CCC correspond to intrauterine infection due to a specific chorioamnionitis, for the following reasons: the rash may occur at birth; experimental cutaneous candidiasis required from 2 to 7 days of incubation; C. albicans has already been demonstrated in the adnexae, even in cases with late onset; culture of C. albicans in multiple sites favours intrauterine infection. Ascending infection of the fetal skin by C. albicans via the birth canal occurs probably through intact membranes, but fissures or late amniocentesis may create a portal of entry. CCC is rare as compared with the frequent maternal carriage of C. albicans.(ABSTRACT TRUNCATED AT 250 WORDS)