Fungal Infections

About skin fungal infections

Fungal infections are the most common of all skin infections. They are particularly common in hot and humid climates. It is popularly known as 'Ringworm'. Contrary to many of the other infections affecting humans, the fungi may cause dermatological conditions that do not involve tissue invasion. On the other hand, the skin surface becomes the habitat of some of these fungi and is liable to environmental contamination.

The main group of fungal infections causing superficial fungal infections are Dermatophytes Yeasts and Moulds.

Symptoms

The symptoms include

• Itching
• Ring-shaped (therefore called as a ringworm) areas
• Red, raised and scaly patch with an inflamed border and a clear or normal-appearing centre

Occurance

Depending on the areas involved the various types of fungal infections of the skin are

• On the scalp and Hair – Tinea Capitis
• On the face and beard area – Tinea Faciei and Tinea Barbae respectively
• On the foot and hand – Tinea Pedis and Tinea Manuum respectively
• On the body – Tinea Corporis
• On the groin and pubic area – Tinea Cruris
• On the nails – Tinea Unguium

Causes

There is a higher risk for fungal infection of the body if you

• Live in damp, humid or crowded conditions
• Have close contact with an infected person or animal
• Share clothing, bedding or towels with someone who has a fungal infection
• Sweat excessively
• Participate in contact sports, such as wrestling, football or rugby
• Wear tight or restricted clothing
• Have a weakened immune system

Types

Tinea Corporis – It is the ringworm of the body's trunk region excluding hands, feet, head and groin areas

Symptoms

• Red to pink circular lesion with scaly or raised edges.
• The centre of the lesion may become less red as the lesion grows towards the periphery.
• Itching of the affected area.

Tinea Cruris – It is also called 'ringworm of the groins' or 'Jock Itch' and is commonly found in males. Predisposing factors could be a warm humid environment, tight clothing, obesity and in some cases chronic steroid application.

Symptoms

• Large scaly, well-demarcated, dull red to brown lesions present in the groins.
• Central clearing of lesions is present.
• The lesions may extend on to the thigh, buttocks.
• Tinea Pedis is commonly present in such patients.
• Intense itching is an associated feature.

Tinea Pedis – It is also known as 'foot ringworm' or 'Athletes' foot' and mostly affects teen and adult males. The risk factors involve sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions.

Symptoms

• Redness, scaling, maceration in the web spaces of the skin between the toes
• Scaling of the soles extending to sides of the feet
• Itchy rash on the feet
• Blisters on the feet

Tinea Capitis – It predominately occurs among children and is acquired by close contact with puppies/kittens or infected children.

Symptoms

• Red, scaly rash on the scalp
• Itching of the scalp
• Hair loss on the scalp
• Rash elsewhere on the body

Tinea Unguium – Toenail infections are more common than fingernail infections and are commonly associated with Tinea Pedis.

Symptoms

• Discolouration of the nail changes to white or green, distal onycholysis (separation of the nail plate from nail fold)
• Damage to nail plate leading to white, crumbly nail surface.
• Complete nail damage.

Common diseases caused by yeast infection are

Candidiasis – This is capable of producing skin and mucous membrane (such as mouth, penis, vagina) infections. Candidiasis is generally a red rash, with a variable degree of itching and soreness. The area may appear macerated with a periphery of papules and pustules. In the mouth, the Candidiasis appears as white plaque and pustules that leave a raw bleeding surface when removed.

Pityriasis versicolor – Pityriasis versicolor occurs more frequently in hot and humid tropical climates like Mumbai. Other factors like oily skin and excessive sweating contribute to the condition. It commonly occurs on the upper part of the body and shoulder areas, and also affects the face, scalp, and below the breasts. The rash presents as multiple white, pink to brown oval to round patches with mild, fine scales. The characteristic of the fungus is that it leaves areas of white patches (hypo pigmentation) that can take up to 12 weeks to return to their normal colour after disease clearance.

Diagnosis

• Ringworm is usually diagnosed by a dermatologist based on assessing the individual's medical history and a physical examination. The clinical presentation is unique.
• The KOH examination is conducted wherein scrapings from the scales can be examined under the microscope following a KOH preparation.
• Nail clippings are required to examine ringworm in the nails.

Treatment

Depending on the type and the site of the infection the treatment is modified. Anti-fungal medications are the main line of treatment.

• Prevention – This is possible by applying powder containing clotrimazole, miconazole to areas prone to fungal infection after bathing.
• Topical Anti-Fungal – Various anti-fungals such as clotrimazole, miconazole, Ketoconazole, terbinafine, ciclopirox olamine can be applied to the lesions generally twice daily.
• Systemic Anti-fungal – Such as Fluconazole, Terbinafine, Itraconazole are given orally in combination with the topical anti-fungal medications.
• Duration of the treatment – This depends on the site and severity of infections. Because fungi can live indefinitely on the skin, a recurrence of infection is possible if treatment schedule is not followed as advised.