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Fungal skin infections

Fungal skin infections

Also known as Dermatophytosis, Fungal infection

Overview

Did you know dandruff, diaper rash, and athlete’s foot are types of fungal infections? According to numerous studies published in the Journal “The Lancet”, fungal skin infections affect more than a billion people worldwide. In some cases they can result in life-threatening infections, however, they often remain the most neglected infection in the general population. 


Fungal skin infections as the name suggests are caused by fungus. These mostly affect the damp areas of the body and skin folds such as between the toes, in the genital area, in the armpits, under the breasts, and in the groin area. These infections are mostly caused by yeast and dermatophytes (a type of fungi that causes superficial infections of the skin, hair, and nails). Poor personal hygiene and living in a hot, humid and crowded environment increases your risk of contracting the infection.


Most of these infections aren’t life-threatening but they can be contagious depending on the type of fungal infection. However, if left ignored, in certain cases they can lead to severe complications. Treatment typically consists of topical therapy like use of antifungal gels, ointments, and sprays or oral medication. Apart from medications, maintaining personal hygiene like keeping your skin/feet dry, wearing well-fitting shoes, etc can help to avoid fungal infections.

Key Facts

Usually seen in
  • All age groups
Gender affected
  • Both men & women
Body part(s) involved
  • Skin
  • Scalp
  • Oral cavity
  • Nails
Prevalence
Mimicking Conditions
  • Annular lesions
  • Nummular eczema
  • Erythema annulare centrifugum
  • Tinea versicolor
  • Cutaneous candidiasis
  • Subacute cutaneous lupus erythematosus
  • Pityriasis rosea
  • Contact dermatitis
  • Atopic dermatitis
  • Seborrheic dermatitis
  • Psoriasis
Necessary health tests/imaging
  • Physical examination
Treatment
Specialists to consult
  • Dermatologist

Causes Of Fungal Skin Infections

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

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

1. Athlete’s foot

Known as tinea pedis, it is a common fungal infection caused by fungi that live on dead tissue of toe nails, space between toes, sole of the feet. The fungus grows preferably in warm and moist environments. Hence, it mostly occurs in people who wear tight shoes, stay in sweaty socks, sports equipment, or by walking barefoot on damp, contaminated floors of common bathing, locker rooms or swimming areas.

The symptoms of an athlete's foot may vary from patient to patient. Common symptoms 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 

  • Skin may become dry, flaky and scale or peel away

  • Infected skin may become soft and start to break down

2. Yeast infection

They are commonly caused by yeast-like fungi Candida. It usually lives inside the digestive system or genitals without causing any harm. But in warm, moist, creased areas of the body such as the groin and armpits, or people suffering from diabetes, obesity or taking some antibiotics, candida can multiply and start to cause symptoms. However, these infections are not contagious. It can present as skin rash like diaper rash (in kids), oral thrush or candidiasis (infection of the mouth), nail fungus, and vaginal yeast infections. The signs and symptoms of various yeast infections are as follows:


3. Cutaneous or skin yeast infection

  • Burning and itching in infected area

  • Rashes

  • Bumps or patches that contain clear fluid


4. Nail yeast infection

  • Toenail fungal infection is very common although fingernails can also get affected.

  • Thick, yellowish or brittle nail that separates from the nail bed

  • Pain and swelling accompanied by pus discharge

5. Oral thrush

  • White or yellow patches involving the tongue, inside your cheeks, tonsils, gums or lips

  • Pain, soreness and burning sensation in the mouth

6. Vaginal yeast infection

  • Redness and soreness on and surrounding the vagina

  • Itching and swelling around the vagina

  • Unusual discharge resembling cottage cheese or a very watery discharge from vagina

  • Burning sensation during urination or coitus


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 in the vagina. Conditions that upset this balance such as prolonged antibiotic therapy, pregnancy, diabetes or HIV infection can lead to vaginal candidiasis. Consult a doctor to get treated.



7. Ringworm infection

Ringworm infection is not caused by a worm (as most commonly misunderstood). Instead, it is caused by a fungus. Known as tinea corporis, it is usually not a serious condition but can be highly contagious. It can spread by coming in direct contact with an infected person, pet, sharing clothes or contaminated items that carry the organism. Heat and humidity also aid in spreading the infection. Ringworm infection can present like:

Ringworm on body: Ringworm is usually very easy to recognise because of its shape. It presents as a ring-shaped rash where the border of the ring is red and slightly raised, while the inside of the ring looks clear or scaly. It may even spread out into several rings. The rash is often bothersome and itchy. It is commonly seen on parts of your body that are exposed, such as your arms, legs or trunk. 

Ringworm on scalp: This fungal infection affects the scalp and the hair shafts. One can get this at any age, but it is mostly seen in children. It is usually transmitted by sharing a hairbrush or clothing contaminated with the fungus. It presents as localized bald, scaly and itchy patches on the scalp. Sometimes, the patches become inflamed and have pus-filled spots. One may also develop a pus-filled area known as a kerion.

Did you know? Ringworm can also affect your pet and you can get infected by handling your pet animal. 

Jock itch: Also known as tinea cruris, jock itch is a fungal infection that presents as an red, itchy and raised rash on the genitals, groin, inner thighs and buttocks. It is more common in men and teenage boys. The fungus favours warm and humid conditions and usually exercising in workout clothes makes it flourish. It is mildly contagious and can spread through close contact with the infected person.

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 in the vagina. Conditions that upset this balance such as prolonged antibiotic therapy, pregnancy, diabetes or HIV infection can lead to vaginal candidiasis. Consult a doctor to get treated.
How is vaginal yeast infection caused?

Risk Factors For Fungal Skin Infections

Some of the common factors that increase your risk of contracting fungal skin infections:

  • Living in warm or wet areas

  • Profuse sweating 

  • Sharing personal items like clothing, towels, shoes or combs

  • Poor personal hygiene like not keeping body clean and dry

  • Wearing tight clothes or footwear

  • Frequent human contact 

  • Contact with animals that may be infected

  • Visiting overcrowded places with poor ventilation

  • Diabetes

  • Obesity/ overweight

  • Immunocompromised individuals suffering from HIV, cancer or undergoing chemotherapy or immunotherapy

Do you know?
Fungal infections are opportunistic, meaning they infect people whose immune system is severely compromised. Such infections can cause symptoms such as fever, cough, and shortness of breath. Fungal infections due to COVID-19 infection are more common in people with severe COVID-19 or those admitted to ICU. The most common fungal infections in patients with COVID-19 include aspergillosis or invasive candidiasis.
Do you know?

Diagnosis Of Fungal Skin Infections

To diagnose a fungal skin infection, your doctor will physically examine the area and look out for rashes, red, flaky and inflamed skin. To find out the specific fungi causing your skin condition, the doctor will scrape off a little amount of skin. This skin is then examined under a microscope or placed in a culture medium where the specific fungus is grown and identified.

Prevention Of Fungal Skin Infections

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:

  • It is advised to keep your feet and skin dry if you are prone to fungal infections.

  • You must shampoo regularly and keep your scalp clean.

  • It is best to avoid sharing personal belongings such as towels, clothes, combs, or other personal care items. If you still use shared items, it is advised to clean and dry them thoroughly before use.

  • Keep your feet covered and wear closed shoes at public places like gyms, public pools and locker rooms.

  • Do not wear tight footwear. Go easy on your feet and wear breathable shoes or open-toed shoes. 

  • Use an antifungal powder in your shoes if you tend to sweat a lot.

  • Don’t wear synthetic socks and change your socks often. 

  • Keep your toenails short and clean.

  • Pay extra attention to the skin around your genital region, and keep it dry. Prefer wearing loose-fitting, cotton underwear.

Specialist To Visit

Consult a doctor and avoid relying on over-the-counter medication if your infection does not improve. It is also important to seek medical help if you are an immunocompromised individual as in those cases a simple skin infection can enter deeper tissues and bloodstream and lead to complications. 

Doctors who can help in the diagnosis and treatment of fungal skin infections are:

  • General physician

  • Dermatologist

Treatment Of Fungal Skin Infections

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


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 (one or more) to be used in the treatment of fungal skin infections:

Home Care For Fungal Skin Infections

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

  1. If you are on an anti-fungal treatment, do not stop the treatment in between. Treat the affected area for as long as it is recommended by your dermatologist. With proper care and treatment, you will start noticing the results within a few days. This will help in ensuring that the ringworm does not reappear after you have stopped continuing the treatment

  2. If you happen to 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.

  3. Keep the infected area clean and dry at all times. The fungus thrives to grow in a warm, and moist environment, so it is advised to keep the area clean and dry.

  4. Avoid wearing clothes, socks, and shoes that make you sweat a lot.

  5. It is advised to use a different towel to dry off uninfected areas.

  6. Treat all fungal infections at the same time. If you treat only one area at a time, you can still have an infection, which can quickly spread to other areas.

  7. It is advised to change your clothes, underwear, gym wear and socks, every day. Wash the clothes before using them again.

  8. It is advised to shower after working out. 

  9. Avoid sharing towels and other items of personal use. Fungal infections can easily spread to others by sharing towels, combs, and other personal items. 

  10. Infected items should be either disinfected or thrown. This includes your clothes, shoes, and other personal items. 

  11. If your treatment isn’t working, it is best to tell your dermatologist and keep regular follow-up. 


The chances of fungal infections increase during the summer season, owing to hot and humid weather conditions and excessive sweating. Here are a few ways to help you deal with fungal infections during the summer season.


Complications Of Fungal Skin Infections

It is rare to see complications in fungal skin infections. One such complication includes Majocchi granuloma. It is a rare skin condition in which the fungi invade your skin via a follicle and go deeper into the dermis or subcutaneous tissues of the skin. Shaving or minor cuts on your skin can predispose patients to Majocchi granuloma. Lesions arising due to Majocchi granuloma involve the hair follicles and the lesions appear as erythematous nodules or papules. These skin lesions can even turn to abscesses in severe cases. 

Alternative Therapies Of Fungal Skin Infections

Home remedies for fungal skin infections


1. Plumbago zeylanica (doctor bush)

The whole plant is crushed with an added pinch of salt and the paste is applied externally in case of ringworm infection.

 

2. Cannabis sativus (ganja)

Ganja or cannabis sativa is externally applied to give relief from itchy skin conditions. Hemp seed oil strengthens your skin and can resist fungal infections. 


3. Aloe vera

Aloe vera is known to be beneficial in various skin diseases. It is often consumed as a health drink. Aloe vera gel is effective in healing wounds and improving blood circulation in the area. Aloe vera gel also has certain properties that are harmful for certain types of fungi. It is thus effective against fungal skin infections.


4. Tea tree oil

Tea tree oil can be applied topically twice a day for the treatment of bacterial and fungal infections.


5. Thyme oil

Thyme oil is extracted from the herb thyme. It can be used topically as an antibacterial and antifungal agent. You can apply it over the affected area for faster relief.

Living With Fungal Skin Infections

Some of the common tips and tricks for people living with fungal skin infections (especially those at high risks like diabetics and obese people) are:

1. Steer clear of high-risk activities

Fungi are widespread but are more prevalent in damp places 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 finishing these activities. 


2. Do not self medicate

It has been reported that people who take antibiotics can develop fungal infections such as vaginal candidiasis. Therefore, it is important to tell your doctor if you are prone to fungal infections and avoid taking antibiotics on your own. 


3. Pay attention to personal hygiene

Hygiene plays an important role in preventing fungal skin infections. It is advised to avoid sharing personal items. Keep your feet clean and dry. Consult your dermatologist if you see a new rash. 


4. Avoid getting fungal infections from pets

Some people may get fungal infections from their pets. If you notice any new circular or irregular patches on your pet, it is best to take them to a veterinarian. This will reduce your chances of contracting the infection. 


5. Take care of your overall health

If you are immunocompromised or have conditions that lower your immunity, then you are at higher risk of fungal infections. Your doctor will prescribe you certain antifungal ointments and powders that will reduce your chances of getting a fungal infection. 

Frequently Asked Questions

References

  1. Ringworm (Tinea). Harvard health publishing.2019 External Link
  2. Candidiasis what is it?Harvard health publishing.Jan 2019 External Link
  3. Jock’s itch (Tinea cruris, What is it. Harvard health publishing. Dec 2018 External Link
  4. Urban Katelyn, Chu Sherman,Scheufele Christian ,Gregory Giesey, R.Delost. The global, regional, and national burden of fungal skin diseases in 195 countries and territories: A cross-sectional analysis from the Global Burden of Disease Study 2017.JAAD International March 2021(2); 22-27. External Link
  5. Denise M. Aaron.Overview of Fungal Skin Infections. Merck manual consumer version.Feb 2021 External Link
  6. Tips to Avoid Fungal Infections. Ciplamed.17 Oct 2016 External Link
  7. Athlete's foot: Overview.InformedHealth.org [Internet].Institute for Quality and Efficiency in Health Care (IQWiG); January 14, 2015 External Link
  8. Jain Akansha, Jain Shubham, Rawat Swati. Emerging fungal infections among children: A review on its clinical manifestations, diagnosis, and prevention.J Pharm Bioallied Sci. 2010 Oct-Dec; 2(4): 314–320. External Link
  9. Garrett Yee; Ahmad M. Al Aboud. Tinea Corporis.Treasure Island (FL): StatPearls Publishing; 2021 Jan External Link
  10. Ringworm: 12 tips for getting the best result from the treatment. American academy of Dermatology External Link
  11. Nahida Tabassum and Mariya Hamdani. Plants used to treat skin diseases.Pharmacogn Rev. 2014 Jan-Jun; 8(15): 52–60 External Link
  12. Fungal Infections - Protect Your Health. Centers for disease control & prevention. External Link
  13. Murlidhar Rajagopalan, Inamadar Arun, Mittal Asit, Miskeen Autar K, Srinivas C. R, Sardana Kabir et al. Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). BMC Dermatology:18(6);(2018) External Link
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