Fungal skin infections

Fungal skin infections are caused by a variety of fungi and yeasts. Some common fungal skin infection-causing microbes include Candida, Malassezia furfur, and dermatophytes such as Microsporum, Epidermophyton, and Trichophyton. These fungi typically inhabit the topmost layer of the epidermis (stratum corneum) and do not penetrate deeper tissues or the bloodstream.

Only some fungi cause infections by attacking a healthy host. Most of these disease-causing fungi are harmless unless they encounter an immunocompromised individual. In such cases, these otherwise benign fungi can invade the defense system of the patient, increasing the risk of infection. Common fungal skin infections include:

• Athlete’s foot (tinea pedis): A common fungal infection caused by fungi that thrive on dead tissue of toenails, spaces between toes, and the soles of the feet. The fungus prefers warm and moist environments, making it prevalent among individuals who wear tight shoes, remain in sweaty socks, use sports equipment, or walk barefoot on damp, contaminated floors in public bathing areas, locker rooms, or swimming pools. Symptoms may vary but commonly include:
  • Redness, itching, stinging, or burning sensations in the infected area, especially between the toes or on the soles of the feet
  • Cracked or blistered skin
  • Dry, flaky skin that may scale or peel away
  • Softened skin that may start to break down
• Yeast infection: Commonly caused by yeast-like fungi, particularly Candida. This fungus typically resides in the digestive system or genitals without causing harm. However, in warm, moist areas of the body, such as the groin and armpits, or in individuals with diabetes, obesity, or those taking antibiotics, Candida can proliferate and lead to symptoms. These infections are not contagious and may present as:
  • Cutaneous or skin yeast infection:
    • Burning and itching in the infected area
    • Rashes
    • Bumps or patches containing clear fluid
  • Nail yeast infection:
    • Commonly affects toenails, but fingernails can also be involved
    • Thick, yellowish, or brittle nails that separate from the nail bed
    • Pain and swelling accompanied by pus discharge
  • Oral thrush:
    • White or yellow patches on the tongue, inside the cheeks, tonsils, gums, or lips
    • Pain, soreness, and burning sensation in the mouth
  • Vaginal yeast infection:
    • Redness and soreness around the vagina
    • Itching and swelling
    • Unusual discharge resembling cottage cheese or a very watery discharge
    • Burning sensation during urination or intercourse
• How is vaginal yeast infection caused? Normally, overgrowth of yeast in the vagina is kept in check by a bacterium called lactobacillus, which maintains an acidic environment. Conditions that disrupt this balance, such as prolonged antibiotic therapy, pregnancy, diabetes, or HIV infection, can lead to vaginal candidiasis. It is advisable to consult a doctor for treatment.
• Ringworm infection: Despite its name, ringworm is not caused by a worm but by a fungus. Known as tinea corporis, it is usually not serious but can be highly contagious. It spreads through direct contact with an infected person, pet, or contaminated items. Heat and humidity facilitate the spread of the infection. Ringworm can manifest as:
  • Ringworm on the body: Recognizable by its ring shape, with a red, slightly raised border and a clear or scaly interior. It may spread into multiple rings and is often itchy.
  • Ringworm on the scalp: Affects the scalp and hair shafts, commonly seen in children. It is transmitted through shared hairbrushes or contaminated clothing, presenting as localized bald, scaly, and itchy patches. Inflammation and pus-filled spots may develop.
  • Jock itch: Also known as tinea cruris, it presents as a red, itchy, and raised rash on the genitals, groin, inner thighs, and buttocks. More common in men and teenage boys, it thrives in warm, humid conditions, often exacerbated by exercising in workout clothes. It is mildly contagious and can spread through close contact.

• Living in warm or wet areas
• Profuse sweating
• Sharing personal items such as clothing, towels, shoes, or combs
• Poor personal hygiene, including not keeping the body clean and dry
• Wearing tight clothing or footwear
• Frequent human contact
• Contact with animals that may be infected
• Visiting overcrowded places with poor ventilation
• Diabetes
• Obesity or being overweight
• Immunocompromised individuals, including those suffering from HIV, cancer, or undergoing chemotherapy or immunotherapy

To diagnose a fungal skin infection, your doctor will physically examine the area and look for:

• Rashes
• Red, flaky, and inflamed skin

To identify the specific fungi causing your skin condition, the doctor will:

• Scrape off a small amount of skin
• Examine the skin under a microscope
• Place the skin sample in a culture medium to grow and identify the specific fungus

Though fungal skin infections are very common and may even occur in healthy individuals, there are certain preventive measures that can help in avoiding the risk of contraction:

• Keep your feet and skin dry if you are prone to fungal infections.
• Shampoo regularly and maintain a clean scalp.
• Avoid sharing personal belongings such as towels, clothes, combs, or other personal care items. If you must use shared items, clean and dry them thoroughly before use.
• Keep your feet covered and wear closed shoes in public places like gyms, public pools, and locker rooms.
• Avoid tight footwear. Choose breathable or open-toed shoes.
• Use antifungal powder in your shoes if you tend to sweat a lot.
• Avoid wearing synthetic socks and change your socks frequently.
• Keep your toenails short and clean.
• Pay extra attention to the skin around your genital region, keeping it dry. Prefer wearing loose-fitting, cotton underwear.

The treatment of fungal infections usually comprises topical or oral preparations. Localized fungal infections are typically treated with topical treatments that need to be applied once or twice a day for two to three weeks. The end goal of antifungal therapy is symptom resolution.

Following are the topical treatments for fungal skin infections:

• Clotrimazole
• Ketoconazole
• Miconazole
• Terbinafine
• Oxiconazole
• Econazole

Treatment with oral therapy is important for more widespread infections or cases that show no improvement with topical treatment. Oral antifungals are expected to clear the condition in about 2 to 3 weeks.

Following are the suggested oral medications to be used in the treatment of fungal skin infections:

• Terbinafine
• Fluconazole
• Itraconazole
• Griseofulvin

You can follow some of these simple tips at home to achieve faster results and relief from fungal skin infections:

• If you are on an anti-fungal treatment, do not stop the treatment midway. Continue treating the affected area for as long as recommended by your dermatologist. With proper care and treatment, results should be noticeable within a few days, helping to ensure that the ringworm does not reappear after treatment is completed.
• If you touch the infected area, wash your hands before touching another area of your body. Touching or scratching the infected area and then touching another area can spread the infection. Washing your hands is the best way to prevent this.
• Keep the infected area clean and dry at all times. The fungus thrives in warm and moist environments, so it is advised to maintain cleanliness and dryness.
• Avoid wearing clothes, socks, and shoes that cause excessive sweating.
• Use a separate towel to dry off uninfected areas.
• Treat all fungal infections simultaneously. If you treat only one area at a time, the infection can still spread to other areas.
• Change your clothes, underwear, gym wear, and socks daily. Wash the clothes before wearing them again.
• Shower after working out.
• Avoid sharing towels and other personal items. Fungal infections can easily spread through shared towels, combs, and other personal belongings.
• Infected items should be disinfected or discarded. This includes clothes, shoes, and other personal items.
• If your treatment isn’t effective, inform your dermatologist and maintain regular follow-ups.
• The likelihood of fungal infections increases during the summer due to hot and humid weather conditions and excessive sweating. Here are a few ways to help you manage fungal infections during the summer season.

It is rare to see complications in fungal skin infections. One such complication includes Majocchi granuloma, a rare skin condition in which the fungi invade the skin via a follicle and penetrate deeper into the dermis or subcutaneous tissues.

Factors that can predispose patients to Majocchi granuloma include:

• Shaving
• Minor cuts on the skin

Lesions arising from Majocchi granuloma involve the hair follicles and typically appear as erythematous nodules or papules. In severe cases, these skin lesions can progress to abscesses.

• Plumbago zeylanica (Doctor Bush): The whole plant is crushed with a pinch of salt, and the paste is applied externally in cases of ringworm infection.
• Cannabis sativa (Ganja): Externally applied to relieve itchy skin conditions. Hemp seed oil strengthens the skin and helps resist fungal infections.
• Aloe vera: Known for its benefits in various skin diseases, it is often consumed as a health drink. Aloe vera gel effectively heals wounds and improves blood circulation. It also possesses properties that are harmful to certain types of fungi, making it effective against fungal skin infections.
• Tea tree oil: Can be applied topically twice a day for the treatment of bacterial and fungal infections.
• Thyme oil: Extracted from the herb thyme, it can be used topically as an antibacterial and antifungal agent. Apply it over the affected area for faster relief.

Some common tips and tricks for individuals living with fungal skin infections, particularly those at higher risk such as diabetics and obese individuals, include:

• Steer clear of high-risk activities: Fungi are widespread but are more prevalent in damp areas such as soil and near water bodies. If you are prone to fungal infections, it is advised to either avoid activities like gardening and swimming or pay close attention to hygiene after these activities.
• Do not self-medicate: It has been reported that individuals who take antibiotics can develop fungal infections, such as vaginal candidiasis. Therefore, it is important to inform your doctor if you are prone to fungal infections and avoid taking antibiotics without medical guidance.
• Pay attention to personal hygiene: Hygiene plays a crucial role in preventing fungal skin infections. It is recommended to avoid sharing personal items, keep your feet clean and dry, and consult your dermatologist if you notice a new rash.
• Avoid getting fungal infections from pets: Some individuals may contract fungal infections from their pets. If you observe any new circular or irregular patches on your pet, it is advisable to take them to a veterinarian to reduce your chances of contracting the infection.
• Take care of your overall health: If you are immunocompromised or have conditions that lower your immunity, you are at a higher risk of fungal infections. Your doctor may prescribe certain antifungal ointments and powders to help reduce your chances of developing a fungal infection.