Cutaneous candidiasis involving scalp or nails is best treated with which option?

• A. Topical antibiotic
• B. Intravenous fluconazole
• C. Oral azole antifungal
• D. Topical steroid

Answer: (C)

Infections on hair-bearing skin or nails require systemic treatment because the fungus hides in deeper layers and within the nail matrix or hair follicles. Topical treatments often don’t reach sufficient concentrations in these areas, so the infection persists or recurs. An oral azole antifungal can reach these tissues through the bloodstream and effectively eradicate Candida at those sites, making it the most reliable option for scalp or nail involvement. Topical antibiotics target bacteria, not fungi, so they’re not helpful. Topical steroids can suppress the local immune response and may worsen fungal infections or delay healing. Intravenous antifungals are typically reserved for more severe disease or when oral therapy isn’t possible, whereas an oral azole is appropriate for localized scalp or nail candidiasis.