Thrush is an infectious disease of the skin and mucous membranes caused by the Candida fungus. It is a specific form of candidiasis. The most common types of thrush are oral thrush and diaper thrush, which is common in babies, but thrush can also occur in skin folds or in the genital area. Below, we introduce you to the different forms of fungal infection and explain how to recognize and treat the symptoms of thrush.
Candidiasis and thrush – definition
Thrush is a subtype of candidiasis (also known as candidiasis or candidamycosis). Candidiasis is a collective name for various infectious diseases caused by excessive proliferation of Candida fungi. These fungi can spread throughout the body via the blood and infect the organs. This is then referred to as systemic candidiasis. This can trigger life-threatening sepsis. If the candidiasis is locally limited to the skin or mucous membranes, this is called thrush. Other names are local candidamycosis or mucocutaneous candidosis. In the past, thrush was also called moniliasis.
Candida: yeast fungus as the cause.
Candida – the fungus that causes candidiasis or thrush – is a genus of yeast fungi. There are about 150 different Candida species, which can be the causative agent of serious fungal infections (mycoses). The most common cause of thrush is the Candida albicans subspecies. Depending on their species, Candida fungi are also found on and in the body of a large proportion of healthy people. The fungi often settle superficially on the skin and mucous membranes, in the mouth and throat or in the colon, and on the external genital organs. As a rule, the contagious fungi are a natural component of the skin, mouth and intestinal flora. They do not cause any discomfort as long as their multiplication is limited by the balance of other microorganisms and the immune system. Problems only arise when the fungi multiply excessively or break through the natural barriers of the skin and mucous membrane. Then thrush infections or systemic candidiasis are often the result.
Fungal infection with many faces
Thrush can affect different parts of the body. The following areas are most commonly affected by the fungal disease:
- Mouth and throat (oral thrush)
- Skin in the diaper area in diaper-wearing babies and adults (diaper thrush, also known as diaper fungus).
- Genital mucosa (vaginal fungal infection or infection of the glans or foreskin).
- Moist body or skin folds, for example, between the toes or fingers, in the groin or anal area (intertriginous candidiasis)
- Nail folds (fingernails and toenails).
- Nipples (breast thrush)
- Esophagus (thrush esophagitis)
Thrush is typically localized. However, a transition to other regions of the body is possible. For example, oral thrush can spread to the pharynx, esophagus or gastrointestinal tract if left untreated. Infection of the blood and serious consequences such as pneumonia or meningitis are also possible. Therefore, thrush should always be treated by a doctor.
Risk factors: Common triggers of thrush
Thrush usually develops only when the body’s natural defense mechanisms fail and the fungi can spread unhindered. Typical risk factors that promote the development of thrush include:
- The use of medications such as antibiotics or cortisone.
- Nutrient deficiency
- Changes in the skin or mucous membrane that facilitate the penetration of the fungus, for example, wounds, lack of ventilation of the skin by bandages or a change in the pH level
- A weakened immune system, for example, due to infections, diseases such as diabetes mellitus, HIV or cancer, or as a result of chemotherapy
- Also children and the elderly often have a weak immune system
- Missing teeth, ill-fitting dentures, smoking or a dry mouth can promote oral thrush
- Thrush on the skin often occurs in people who have occupationally moist skin (for example, cleaners) or in the skin folds of people who are very overweight
- Babies and newborns often suffer from oral thrush or diaper thrush. The latter is caused by wearing diapers, under which the fungus finds an ideal warm and humid climate
- During breastfeeding, mother and child often infect each other.The mother’s nipples often become diseased as a result of moisture under the nursing pads or oral thrush of the baby
Typical symptoms
Depending on the affected area of the body, thrush causes different symptoms. The following signs are typical of fungal infection of the skin and mucous membranes:
- Oral thrush: white, easily detachable coatings as well as a reddened mucous membrane in the oral cavity, on the tongue or in the throat. Depending on the form, the plaques may also be fixed or absent. Here are details of the symptoms of oral thrush.
- Skin thrush (usually in skin folds, for example, under the breasts, armpits or groin): severe redness, scales, pustules, itching, sometimes a burning sensation and pain.
- Thrush on toenails and fingernails: Redness, swelling and pain to the touch.
- Vaginal thrush (often favored by high estrogen levels in pregnancy): itching, burning, redness and swelling of the mucous membrane, whitish coating, sometimes crumbly white discharge.
- Thrush on the glans (thrush balanitis) or on the foreskin (thrush balanoposthitis): burning, itching, inflammation of the glans or foreskin, respectively, pustules and small vesicles.
- Thrush on the breast: pink-colored, sometimes shiny, sore nipples, itching, burning, pain, swelling, dry and scaly skin, sometimes with white coatings or vesicles.
- Diaper thrush: red, white-edged pustules, scales, reddened, inflamed skin in the diaper area, sometimes also in the area of the thighs, abdomen or back, often associated with diaper dermatitis
Smear allows the diagnosis
The diagnosis of thrush – yes, depending on the type of thrush – can be made in some cases already on the basis of the symptoms. Usually, the doctor also inquires about previous diseases and asks whether medication is taken or other risk factors are present. Microscopic examination of a swab or samples of infected skin or mucous membrane is the most common method of detecting thrush and can normally confirm the diagnosis quickly. This is often necessary, especially in adults, to rule out other diseases with similar symptoms. If no symptoms are present, a positive test for Candida fungi is not considered evidence of thrush or candidiasis, since the yeast fungus is also present in many healthy people.
Other methods for detecting thrush
If necessary, further imaging procedures, such as a gastroscopy in the case of thrush infestation of the esophagus, may be necessary for the definitive diagnosis of thrush, for example to remove a tissue sample. A blood test can also be used to detect antibodies against the Candida fungus. However, this procedure is controversial and usually not necessary. If necessary, fungal cultures can be used to determine the exact type of yeast fungus. This is of particular interest when an administered medication does not respond and resistance of the fungus is suspected.
What helps with thrush infection?
Treatment of the various forms of thrush is done with the help of locally applied antifungal agents. Commonly used agents include nystatin, amphotericin B, clotrimazole, fluconazole, and itraconazole. If the agents are used as prescribed for the recommended duration of therapy, thrush can usually be quickly and easily controlled – thrush is considered to be easily cured. Depending on the affected part of the body, various preparations against thrush are available, for example as:
- Solution
- Mouthwash
- Cream or ointment
- Nail polish
- Tablet
- Suppository
Homeopathic remedies and home remedies can be used in consultation with the doctor supportive. However, it is strongly discouraged to treat thrush exclusively with homeopathy or home remedies.
Thrush often returns
When treating thrush, it is important to follow the doctor’s instructions exactly and to use the antifungal drug for the prescribed duration. Otherwise, premature discontinuation of therapy can quickly lead to a relapse or spread of the fungal disease. To prevent recurrence of thrush, the cause should also always be eliminated if possible, i.e. the triggering underlying disease should be treated, for example. If no obvious risk factors can be identified, it is important to clarify the causes of the outbreak of thrush infection.Often thrush is the first sign of a weakened immune system due to a previously unnoticed disease, such as diabetes or HIV.
Complementary measures for treatment
Drug treatment of thrush should always be supplemented by appropriate hygiene measures to avoid spreading the infection. In general, the thrush infection should not be touched with bare hands to prevent smear infection. The other complementary measures depend on the type of thrush infection:
- After contact of the Candida fungi to clothing, towels or bed linen should be washed at least 60 ° C or with appropriate hygiene rinse.
- For thrush in skin folds, it is important to ensure adequate ventilation of the affected areas. To keep the skin dry here, for example, gauze strips can be placed in the skin folds.
- In the case of oral thrush, oral hygiene items such as toothbrushes should be replaced – the same applies to pacifiers or teats. With regard to dentures or braces, a thorough cleaning is recommended.
- In the case of diaper thrush, care should be taken to keep the diaper area clean and dry and ventilated regularly. Always fresh diaper pads are necessary to avoid spreading the fungal infection.
Often people affected by thrush are advised to follow a diet low in carbohydrates and sugar, because the Candida fungus feeds on sugar. However, the effectiveness of this anti-fungal diet is controversial.
Infection with Candida fungi
Candida fungi can easily be spread to other areas of the body or from one person to another. Follow these tips to prevent infecting others:
- If a thrush infection is present in the genital area, it is recommended to use condoms, as the disease can be transmitted through sexual intercourse.
- Oral thrush in babies often leads to infestation of the nipples in nursing mothers and vice versa. Therefore, treatment should usually include both mother and child and refrain from breastfeeding for the duration of the infestation.
- Candida fungi often settle in the oral cavity and are then transmissible through saliva. Kissing or drinking together from a glass can be enough for infection.
- Candida fungi can also be transmitted via the hands – for example, from parents to their newborn. Therefore, good hand hygiene is particularly important when dealing with babies.
Prevention of thrush
Candida fungi, the causative agents of thrush, are also widespread in healthy people, but cause symptoms only when the immune system is weakened. Therefore, thrush can only be prevented to a limited extent. Strengthening the immune system through a healthy lifestyle and a balanced diet, hygiene – especially in the intimate area – and the use of condoms can help prevent infection with the fungi. People whose immune systems are weakened, for example, due to illness or long-term use of medications, should be especially aware of the risk of thrush infection and pay close attention to possible signs.
Prevent diaper thrush and oral thrush in babies
To prevent thrush in babies, it is recommended to rule out vaginal thrush in the mother before birth, otherwise the baby could be infected with the Candida fungi at birth. However, the child can also become infected later, for example via the saliva or the hands of the parents. To prevent oral thrush, parents should pay particular attention to the hygiene of pacifiers, teething rings and teats. Mothers who breastfeed their children should also prevent inflamed nipples, for example by changing nursing pads frequently. Bathing the baby too often or too infrequently, as well as changing diapers too infrequently, can upset the baby’s skin environment, promoting diaper thrush.
