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10 common fungal infections that affect the skin - Perdana University
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10 common fungal infections that affect the skin

10 common fungal infections that affect the skin

The article below appeared in the January 31  issue of Health with Perdana, a regular column in The Star by Perdana University faculty members. This week’s article is contributed by Assoc. Prof. Dr. Mohammad Nazmul Hasan Maziz, an associate professor in medical microbiology and deputy dean of the Perdana University Graduate School of Medicine.

 

Fungi come in many shapes and forms.

We are probably most familiar with them in the form of edible mushrooms.

They are also important elements in many processes in the food, agriculture, petroleum and pharmaceutical industries.

For example, the very first antibiotic, penicillin, is made from its namesake fungus, Penicillium sp.

However, fungi can also cause infections in different parts of our body, especially our skin.

Fungal skin infections commonly affect the outer layer of the skin, nails and hair.

Most of the fungi causing infections are dermatophytes (which cause tinea), yeast (candidiasis) and moulds.

Fungi usually make their home in moist areas of the body where skin surfaces meet, e.g. between the toes, in the genital area and under the breasts.

However, they can cause infections in dry areas too.

Some common fungal skin infections are:

  • Tinea pedis

    This is a dermatophytic infection of the feet most commonly known as athlete’s foot, kulat air or “kaki makan air”.

    It occurs in the area between toes and around the foot below the ankle.

    Hot, humid weather; tight, enclosed footwear; and excessive sweating; are some of the predisposing factors.

    Most cases are caused by one of three dermatophytes, i.e. Trichophyton rubrum (the most common and the resistant to treatment), T. mentagrophytes var. interdigitale and Epidermophyton floccosum.

    Athlete’s foot is contagious and can be passed through direct contact or contact with contaminated items such as shoes, socks and shower or pool surfaces.

    Symptoms include itchiness, redness, burning or stinging pain, and blisters that ooze or get crusty.

    If the fungus spreads to the nails, they become discoloured (white or yellow), thick, and may even crumble.

    Tinea pedis skin lesions can be classified as interdigital, ulcerative, moccasin or inflammatory.

    The interdigital type of tinea pedis is the most common.

    It is characterised by fissuring (a deep and narrow split or crack in the skin), maceration (the softening of dead tissue) and scaling (dry, cracked or flaking skin) in the interdigital space between the fourth and fifth toes.

    Tinea pedis is treated with topical and/or oral antifungals.

  • Tinea cruris

    Tinea cruris, frequently called jock itch, is a dermatophytic infection of the groin.

    It is the second most common clinical presentation for this type of fungal infection.

    Most cases are caused by one of two dermatophytes: T. rubrum and T. mentagrophytes.

    It is more common in men than in women, and is frequently associated with tinea pedis.

    Tinea cruris occurs when ambient temperature and humidity are high.

    Wearing wet or tight-fitting clothing provides an optimal environment for infection.

    A warm and humid environment; tight clothing, especially when worn by men; obesity; and long-term use of glucocorticoids on the skin; are some of the predisposing factors.

    Tinea cruris not only affects the groin area, but can also affect the inside area of the thighs nearest to the groin, the buttocks and the abdomen.

    Symptoms include a burning sensation, itchiness, and pustules and vesicles at the active edge of the infected area.

    Tinea cruris is treated with hydrocortisone cream and clotrimazole cream on the affected area, as well as liberal application of zinc oxide ointment.

  • Tinea corporis

    Tinea corporis, or ringworm, typically appears as single or multiple, annular (ring-like), scaly lesions with a central clear space and a slightly elevated, reddened edge with clearly-defined borders on the trunk, extremities or face.

    The border of the lesion may contain pustules or follicular papules.

    This infection is more common in children.

    It is caused by dermatophytes, including T. rubrum and Microsporum canis.

    Exposure to infected animals and long-term use of glucocorticoids on the skin are some of the predisposing factors.

    Symptoms include itchiness, sensitivity to light, a well-circumscribed infected area of variable size and hyperpigmentation. among others.

    Tinea corporis is treated with imidazole cream or Whitfield’s ointment.

    Mild steroids may be added in cases with severe itching.

  • Tinea faciei

    Tinea faciei, also known as tinea faciale or facial ringworm, is a common infection of the facial skin caused by a dermatophyte.

    The infection tends to occur in the non-bearded areas of the face.

    The patient may complain of itching and burning, which becomes worse after sunlight exposure.

    Some round or annular red patches are usually present.

    Often, however, the red areas may be indistinct, especially on darkly-pigmented skin, and lesions may have little or no scaling, or raised edges.

    Because of its subtle appearance, this infection is sometimes known as tinea incognito – a term used for unrecognised fungal infections in patients treated with steroids.

    The lesions usually do not come with any other symptoms, but may sometimes be very itchy, or even painful.

    Tinea faciei is treated with topical antifungal creams such as azoles and terbinafine.

  • Tinea capitis

    Tinea capitis, or ringworm of the scalp, is an infection of the scalp and hair shafts.

    It is the most common tinea infection in children and is caused by T. tonsuransM. audouiniiM. gypseumT. rubrum and T. mentagrophytes.

    Ringworm is a highly contagious infection and can spread through direct contact or by sharing combs, towels, hats or pillows.

    Symptoms include pain, tenderness, scaling, itchiness, and loss of hair – sometimes extensively – with atrophy, scarring and so-called scutula, i.e. yellowish crusts on the scalp.

    Tinea capitis is treated with griseofulvin, Whitfield’s ointment or miconazole.

  • Tinea unguium

Tinea unguium, or onychomycosis, is a fungal infection of the nail.

This condition may affect either toenails or fingernails, but is particularly common in toenails.

It is caused by T. rubrumT. mentagrophytesE. floccosumT. violaceumT. schoenleinii and T. verrucosum.

Ageing, diabetes, poorly-fitting shoes and the presence of tinea pedis are some of the predisposing factors.

Three types of symptoms are usually seen:

    • A white patch on the tips or sides of the undersurface of the nail and nail bed, typically with sharply demarcated borders.

      In time, the white can become discoloured to a brown or black hue.

    • A white chalky plaque on the base of the nail plate, which may become eroded, resulting in the loss of the nail plate.
    • A white spot beneath the base of the nail fold.

      In time, the discolouration can spread to the rest of the undersurface of the nail.

Tinea unguium is treated with itraconazole.

  • Tinea barbae

    Tinea barbae involves the skin and coarse hairs of the beard and moustache area.

    This dermatophyte infection occurs in adult men and hairy women.

    It is caused by T. mentagrophytes or T. verrucosum.

    It affects farm workers the most as these particular fungi prefer to reside on animals.

    Symptoms include deep red kerion-like (abscess-like) plaques and superficial patches resembling tinea corporis or bacterial folliculitis.

    It may also cause scaling, follicular pustules and redness.

    Tinea barbae is treated with antifungal drugs such as griseofulvin, terbinafine or itraconazole.

  • Tinea manuum

    Tinea manuum is a fungal infection of one, or occasionally, both hands.

    It often occurs in patients with tinea pedis.

    It is caused by T. rubrumT. mentagrophytes and E. floccosum.

    The infected area will be itchy, red and have a scaly appearance.

    It may also peel and flake, or blister with a clear liquid.

    Infected palms are usually very dry and develop thick skin.

    When fingernails are involved, vesicles and scant scaling may be present, and they tend to resemble dyshidrotic eczema.

    Infected areas normally start small and become larger over time.

    Tinea manuum is treated with long-term use of selenium sulphide shampoo, and in some cases, griseofulvin.

  • Tinea versicolor

    Tinea versicolor, also known as pityriasis versicolor, is a fungal infection of the trunk, usually of fair-skinned individuals exposed to the sun.

    It affects mainly the upper back, chest and arms, and is caused by the yeast called Malassezia furfur.

    Warm climates, hyperhidrosis (excessive sweating), aerobic exercise, oily skin, glucocorticoid treatment, immunodeficiency and application of lipids such as cocoa butter are some of the predisposing factors.

    Symptoms include well-defined macular lesions with fine scales, which tend to be white in suntanned areas and brown on pale skin.

    Tinea versicolor is treated with selenium sulphide 2.5% suspension and antifungals like miconazole, clotrimazole, ketoconazole and triconazole.

  • Cutaneous candidiasis

    Cutaneous candidiasis can involve almost any part of the skin, but most often occurs in warm, moist, creased areas such as the armpits and groin.

    The most common cause is Candida albicans.

    Infants and elderly or immobilised patients are prone to this infection.

    Symptoms include itching, soreness, a mild discharge and red macules, often with small pustules on their periphery.

    Cutaneous candidiasis is treated with nystatin ointment or cream and antifungals like imidazole and miconazole.

 

Prevention

To prevent fungal skin infections, we should protect our skin as much as possible with the following measures:

  • Practising good hygiene
  • Wearing clean clothes every day, especially socks and underwear
  • Avoiding the sharing of clothes, towels or other personal items
  • Avoiding clothing or shoes that are too tight or have a restrictive fit
  • Wearing clothes and shoes that breathe well
  • Drying off properly with a clean dry towel after showering, bathing or swimming
  • Avoiding walking with bare feet
  • Staying away from animals that have signs of a fungal infection
  • Keeping your groin clean and dry
  • Completing your course of antifungal medicine, even if the infection disappears.

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