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

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

Answer: (A)

Fungal infections of the scalp or nails need systemic therapy because these keratinized tissues are hard for topical drugs to reach. Oral azole antifungals circulate throughout the body and achieve therapeutic levels in the hair follicles and nail beds, making them the most effective option for Candida infections in these locations. Fluconazole or itraconazole are common choices and are used for extended durations to account for slow nail growth and the persistence of infection.

Topical antibiotics treat bacteria, not fungi, so they won’t address a Candida infection. Topical steroids can suppress local immunity and may worsen fungal growth, potentially allowing the infection to spread. Oral antibiotics have no antifungal activity, so they’re not appropriate for candidiasis.