Chronic Mucocutaneous Candidiasis

ByJames Fernandez, MD, PhD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Reviewed/Revised Jan 2023 | Modified Sep 2023

Chronic mucocutaneous candidiasis, a hereditary immunodeficiency disorder, is persistent or recurring infection with Candida (a fungus) due to malfunction of T cells (a type of white blood cell).

  • Chronic mucocutaneous candidiasis causes frequent or chronic fungal infections of the mouth, scalp, skin, and nails.

  • To diagnose the disorder, doctors examine a sample from the infected area under a microscope and do blood tests to check for the mutations that cause the immunodeficiency.

  • Antifungal drugs can usually control the infection, but they must be taken for a long time.

(See also Overview of Immunodeficiency Disorders.)

Because T cells (a type of lymphocyte) malfunction, the body is less able to fight fungal infections, including infection with Candida (candidiasis), a yeast. If other parts of the immune system (such as antibodies) are functioning, the body may still be able to fight against other infections. However, in some people with this disorder, antibodies also malfunction, making these people susceptible to other infections.

Chronic mucocutaneous candidiasis is due to a mutation in specific genes. Depending on which gene has the mutation, one or two mutations (one from each parent) may be needed to cause the disorder.

Symptoms of Chronic Mucocutaneous Candidiasis

In people with chronic mucocutaneous candidiasis, candidal infections develop and recur or persist, usually beginning during infancy but sometimes during early adulthood.

The fungus may cause mouth infections (thrush) and infections of the scalp, skin, and nails. Membranes lining the mouth, esophagus, digestive tract, eyelids, and vagina (vaginal yeast infection) may also be infected.

In infants, the first symptoms are often thrush that is difficult to treat, diaper rash, or both. Severity varies.

Chronic mucocutaneous candidiasis may cause one or more nails to thicken, crack, and become discolored. A disfiguring rash may cover the face and scalp. The rash is crusted and thick and may ooze. On the scalp, the rash may cause hair to fall out.

Candidal Infections
Nail Infection (Candidiasis)
Nail Infection (Candidiasis)
Nail infections caused by Candida can affect the nail plate (onychomycosis—seen at the bottom of the nail), the edges o... read more

Image courtesy of CDC/Sherry Brinkman via the Public Health Image Library of the Centers for Disease Control and Prevention.

Creamy white patches are seen inside the mouth and may bleed when scraped off. This finding is typical of thrush, which... read more

Image provided by Thomas Habif, MD.

Infection of the Esophagus Caused by Candida
Infection of the Esophagus Caused by Candida
This photo shows whitish spots in the esophagus that are typical of infection with the yeast Candida.

Photo provided by Kristle Lynch, MD.

Usually, this disorder is chronic, but it does not affect life span.

Many people also have the following:

Diagnosis of Chronic Mucocutaneous Candidiasis

  • Examination of a sample from the infected area under a microscope

  • Sometimes genetic testing

Doctors suspect Candida infection when people frequently have mouth, scalp, skin, and nail infections with the characteristic skin changes. Examining a sample from the infected area under a microscope and identifying the yeast can confirm that a Candida infection is the cause.

Because people without an immunodeficiency disorder occasionally develop Candida infection, doctors then check for common risk factors for Candida infection, such as diabetes or recent use of antibiotics. If people with frequent Candida infections have no risk factors for Candida infections, the diagnosis is likely to be chronic mucocutaneous candidiasis.

Blood tests to check for a specific genetic mutation can confirm the diagnosis.

Treatment of Chronic Mucocutaneous Candidiasis

  • Antifungal drugs

  • Sometimes immune globulin

Immune globulin (antibodies obtained from the blood of people with a normal immune system) is sometimes given. It may be injected into a vein (intravenously) once a month or under the skin (subcutaneously) once a week or once a month.

Endocrine and autoimmune disorders are treated as needed.

Stem cell transplantation has been used in a few people with specific genetic mutations; however, transplantation is not often used in people with chronic mucocutaneous candidiasis.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  1. Immune Deficiency Foundation: Other Primary Cellular Immunodeficiencies: General information on chronic mucocutaneous candidiasis and other primary cellular immunodeficiencies, including information on diagnosis and treatment

Drugs Mentioned In This Article
Test your KnowledgeTake a Quiz!
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID
Download the free Merck Manual App iOS ANDROID