Fungal Infections

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Types

Athlete's Foot (Tinea Pedis)
Perhaps the best-known fungus infection of the skin is athlete's foot, or tinea pedis. Possibly 10% of the U.S. population has athlete's foot at any given time. It is more common among adults and adolescents; however, people of any age may contract it.

There are four variants of athlete's foot. The most common form involves the webs between the toes, particularly between the fourth and fifth toes. From there it may spread to the soles or other parts of the feet. Sweating and moisture may be an underlying cause.

Another variant, known as moccasin-type tinea pedis, appears as diffuse, somewhat thick scaling over the entire sole (like a moccasin or slipper). It is usually seen on both sides of the feet.

In the third variation, vesicular type, small blisters are typical, especially near the instep of the foot. This type is quite itchy.

In the fourth variation there is skin peeling and an oozing fluid discharge. White areas are often seen, and there is a strong odor. This may be due to a concomitant bacterial infection. This type usually starts as red, itchy inflammation between the toes.

Tinea pedis is difficult to eliminate and often comes back. There are a number of antifungal medications that are effective in treating athlete's foot and other fungal infections. Some are over-the-counter and others require a prescription. The medications may be topical (applied to the skin) or oral (swallowed). Sometimes a bacterial infection occurs along with the fungal infection. In that case, an antibiotic may be prescribed.

Ringworm (Tinea Corporis)
Despite the name, a worm does not cause ringworm. Tinea corporis is a fungal infection. People of any age contract ringworm, but it is more common in children. A related form is tinea cruris or "jock itch," a fungal infection of the groin area.

In some cases, the rash has a raised circular shape, which suggests the presence of a worm. However, generalized rashes and scaling also appear. The rash usually begins as a reddish bump. As it grows, the interior seems to clear, forming the ring-like shape. Sometimes several rings develop and merge. Swelling and blisters may also appear.

Mild cases of ringworm respond well to topical medications. More severe cases, however, may require oral antifungals.

Tinea Capitis
Tinea capitis is a fungal infection that affects the scalp and hair. It usually occurs in very young children, though it can appear in all age groups. The fungi that cause tinea capitis can be passed from person to person. This is especially likely when groups of children are in close quarters, such as in a school or a day-care setting.

Many objects that commonly come in contact with the head—such as hats, combs, brushes, pillows, and headrests—can harbor infectious fungi. Pets can carry infectious fungi. Even a stray hair from someone with the infection can pass an organism. Fungi can live for weeks or months in a dormant state on hair samples.

The usual effect of tinea capitis is patchy hair loss (alopecia) with a scaly rash. Small spots of hair remain in a random pattern in the bare areas. This tends to spread to larger areas of the head. The lymph nodes in the back of the neck are usually swollen.

A more severe form of tinea capitis involves a mass called a kerion. The kerion is a large, bulky, oozing rash. The patient experiences pain, swelling, and, sometimes, fever. Without treatment, a kerion can leave permanent scarring and hair loss.

Because the infected hairs are deep in the follicle and topical medication cannot penetrate to the infected areas, treatment requires oral medication. Griseofulvin (about 20 milligrams per kilogram of body weight) is the most commonly prescribed therapy. Treatment lasts 1 to 3 months or until all signs of infection are eliminated. In cases with large, swollen, and inflamed areas, a short course of oral corticosteroids may be prescribed to reduce swelling and minimize scarring. Some doctors may consider surgery in extremely severe cases.

When tinea capitis is diagnosed, it is important that all family members be examined for signs of infection and to see if they are asymptomatic carriers. All brushes, combs, pillowcases, hats, and so on should be disinfected with antifungal shampoo. Affected individuals and their family members are encouraged to use antifungal shampoo for 2 weeks to minimize spreading infection. Since the fungi that cause tinea capitis can be transmitted from animals, especially kittens and puppies, all pets should be examined and treated if necessary.

Onychomycosis
Onychomycosis, fungal infection of the nails, often stems from untreated athlete's foot or tinea manuum (fungal infection of the hands). Although it can appear in younger children, it is much more common in adolescents and adults. People who have their nails manicured often, particularly when the cuticles are trimmed, are more susceptible to nail infections.

There are four main forms of this disorder. The most common is distal subungual onychomycosis. At first, the nail thickens and becomes brittle. The infection can spread to the entire nail, discoloring, thickening, and lifting it.

Candida onychomycosis is caused by the yeast candida. Symptoms include detachment of the nail, reddening, and swelling.

In white superficial onychomycosis, a white brittle coating appears on the nail surface while the underlying structure remains intact.

The fourth and least common form is proximal subungual onychomycosis. The fungal growth spreads outward from the cuticle. This appears most often in people with AIDS and seems to be a result of reduced immune system response. The doctor may recommend that the patient undergo testing for human immunodeficiency virus (HIV, the virus that causes AIDS).

Not all thickened and discolored nails are caused by fungal infection. Psoriasis, eczema, and some inherited disorders can cause similar nail damage. Accurate diagnosis depends on microscopic examination of the debris after application of potassium hydroxide and heat to the specimen.

The hard surface of the nails usually prevents penetration by topical medications, so doctors usually prescribe oral antifungals. Treatment may require removing part or all of an affected nail.

See also: more information on onychomycosis.

Tinea Versicolor
This is a fungal infection of the outermost layer of the skin. Also known as pityriasis versicolor, it can appear anywhere on the body. It is most prevalent among adolescents and adults but can affect children. The main symptom is discoloration. Variable pink, white, or brown patches develop on the skin. A powdery coating is also present.

This disorder occurs when the fungus Pityrosporum invades the skin. It can remain dormant within the hair follicles for long periods of time. With proper moisture and temperature conditions (such as humid summer weather), the fungus becomes active and reproduces. The use of corticosteroids can foster the growth of this organism.

Because of the unique characteristics of the rash, doctors usually identify tinea versicolor on appearance alone. Topical antifungals are usually used for treatment because the infection is on the surface of the skin rather than in deeper tissue.

Doctors may recommend selenium sulfide or a number of creams, lotions, or shampoos. In severe cases, oral antifungals may be necessary. It can take several months for the skin's normal color to return.

Cutaneous Candidiasis
The yeast candida causes fungal infections. Many people are familiar with yeast infections of the vagina. However, most are not aware that small populations of yeast are always living in the membranes lining the mouth, vagina, and intestines.

Yeast populations are usually controlled by competition with bacteria and by the body's defenses. When the bacteria-yeast balance shifts or the immune system is compromised, yeast infections can occur. When they develop on the skin, they are known as cutaneous candidiasis.

Symptoms include a red rash with itching and moist peeling. There may be pus-filled bumps around the edges.

Areas of the skin that are moist and folded—such as the groin, the skin under the breasts, and areas between skin folds of obese persons—are more likely to harbor the infection. Urine, saliva, and sweat are all moisture sources for candida.

Many topical antifungals are used to treat cutaneous candidiasis. Those in powder form can simultaneously dry moist areas. In more severe cases, the doctor may prescribe oral antifungals. When treating candidiasis, it is important to address any underlying predisposition, such as high blood sugar.

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