This article is intended for people suffering from fungal skin infections or those who would like to know and learn something more. A certain type of fungus or excessive growth of a normal harmless type of fungus causes symptoms of a fungal skin infection. There are about 40 species of fungi but only five are the most common. Fungal infections or dermatophytosis can be divided according to the cause that causes them and according to where they are usually found on the body. Fungal skin infections are usually treated very effectively.
What are fungal skin infections?
Fungal infections are infections of the skin caused by fungi. There are many different types of fungal skin infections.
What do the symptoms depend on?
The symptoms and occurrence of fungal skin infections depend on the type of fungus.
Fungi can cause various forms of rash. Some are red, scaly and itchy, while others can only produce scales on dry skin. Fungi can infect only one part of the body, but several parts of the body can be infected at the same time.
Why are we afraid of fungal infections in the hair and scalp?
Fungal infections of the scalp or chin can lead tohair loss.
Can fungal disease be confused with other skin diseases?
Yes. Fungal rash is sometimes difficult to distinguish from other skin diseases such as psoriasis or eczema.
Types of fungal skin infections
Fungal infections or dermatophytosis usually affect the skin, ie. its constituent keratin. Fungal infections are divided into groups depending on which parts of the body are affected on which the full name of the disease also depends.
They can be considered in two ways, by clinical appearance and by biological origin where we distinguish three genera and many of their subspecies.
The most common division according to body involvement and clinical appearance is:
- Tinea pedis (feet)
- Tinea unguis (nails)
- Tinea cruris (groin)
- Tinea corporis (hull)
- Tinea kapitis (scalp)
- Tinea barbae (chin)
- Tinea faciei (face)
- Tinea manus (hands),
Some common fungal infections are listed below.
Athlets foot (Tinea pedis)
It is a disease that involves moist peeling of the skin commonly in the area between the toes. Sometimes the skin becomes pale and may itch. It is very common and occurs in one in five adults. It is usually caused by a combination of fungi and bacteria. The skin is usually infected in contaminated public places such as swimming pools and showers.
Nail infections
Onychomycosis is the name for a fungal nail infection and its synonym is Tinea unguium (nail rings) which is also often used.
What does a fungal nail infection look like?
The nail becomes malformed, coated and crumbly. Not all nails are usually affected and they are often part of the athletic foot. Fingernails can also be affected.
Fungal rings in the groin (Tinea cruris)
This is called “athletic itching” because it occurs in athletes. Symptoms include itching, a red rash in the groin and surrounding area and are most commonly seen in men who sweat a lot.
Fungal rings on the body (Tinea corporis)
The body is usually affected in exposed areas such as the abdomen or limbs causing red spots. It usually spreads from person to person. Most infected do not eventually develop symptoms, but become a vector that can spread the infection to others, sometimes for years.
According to the place where the fungi persist and from where they spread, there are three types of fungi:
Anthropophilic fungi
These are fungi that persist in humans. They are generally well adapted to host people and elicit a weak immune response making them difficult to eliminate and treat. Examples are Trichophyton rubrum, Trichophyton mentagrophytes var. interdigitale, Trichophyton schoenleini and Microsporum audoinii.
Zoophilic fungi
They are common in animals. Infections in pets or farm animals are usually mild or vague so animals are usually just a vector. When a person becomes infected with them, an appropriate immune response occurs which usually leads to spontaneous healing. Some members of this group are Microsporum canis, Trichophiton mentagrophytes var. interdigitalis and Trichophyton verrucosum.
Geophilic fungi
These are the fungi that occur most rarely as a cause of disease. These fungi are found in the soil or in plant material. The best known example is Microsporum gypseum.
Tinea pedis is perhaps the most common human infection, which is associated with tinea inguinalis and tinea unguium. Men are far more often infected than women. Children are unlikely to get tinea pedis but most often have anthropophilic tinea capitis.
Risk factors for getting fungal infections are as follows:
- if you have recently taken a course of antibiotics
- if you have been taking oral steroids
- if you have diabetes mellitus
- if you are overweight
- if you are an African Caribbean
- you have a weakened immune system with a disease such as a tumor or AIDS.
Wet skin greatly contributes to fungal infections and this means fungal infections are much more likely when the skin is not dry after sweating or bathing or when it is covered with a material that does not allow sweat to evaporate. Damage to the skin surface such as cuts or scratches can also encourage fungi to grow.
Fungal infections within the body so called. systemic mycoses affect only people whose immune system is severely weakened due to severe diseases such as AIDS, but also due to immunosuppressive therapy taken after organ transplantation.
How do fungal infections spread?
Fungal infections are spread by contact. For example, the “athletic foot” spreads in joint collectives such as gymnastics and swimming pools. Contact with sheets or towels can also spread a fungal infection. A fungal infection can be acquired by contact with animals such as a cat or dog or much less frequently than cattle.
Treatment
The most common fungal skin infections are superficial infections so the drugs are usually applied directly to the skin (topical treatment). For this there are various forms of treatments available in the form of creams, lotions or medicated powders. If the rash affects a large area of skin, nails or scalp, then tabletsmust be used in the treatment.
Is there a possibility of recurrence?
Recurrence is possible and the rash may return even when it appears to be cured. Treatment should therefore last at least four weeks.
How to prevent fungal infections?
- dry your skin carefully after bathing
- wear loose suitable clothing and underwear
- avoid exchanging towels for hair brushes and combs that could contain a skin fragment that is a refuge for fungal colonies
- change socks or tights daily
- for an athletic foot, change your shoes every two or three days so that they have time to dry
- allow the skin to breathe – natural fibers such as cotton are better for underwear than nylon or polyester
- It is good for athletes to use synthetic fibers that “tampon” sweat outside the body, helping to preserve dry skin.
- If you have diabetes you need to control your blood sugar
The most common fungal infections by type of causative agent are:
1. Microsporosis (the cause of Microsporum)
2. Epidermophytosis (caused by Epidermophyton)
3. Trichophytosis (causative agent of Trichophyton)
4. Candidiasis (the cause of the yeast Candida)
Microsporosis
What is microsporosis?
It is a fungal skin infection caused by a fungus of the genus Microsporum.
What is the cause?
The most common causes are Microsporum canis (the source of which is most often an infected cat or dog) and Microsporum audoini (transmitted directly from human to human)
What does that cause look like?
Microsporum species consists of macro and microconidia on short conidiophores.
The difference from Trichophyton is based on the roughness of the macroconidial cell wall although this is difficult to distinguish in practice.
What are the species of Microsporum and how many are there?
Seventeen species have been described so far, but here we mention only the most common species:
- Microsporum audouinii
- Microsporum canis
- Microsporum gallinae
- Microsporum gypseum
- Microsporum nanum
What is the clinical picture?
On the bare skin of any part of the body (face, neck, scalp, legs) that is in contact with an infected animal, round red foci one to two centimeters in size appear with a pronounced red, scaly edge. In the center of the focus, the redness decreases and the edge expands.
When does it most often appear?
It most often occurs in late summer and autumn in children of preschool and school age, while it occurs less frequently in other age groups.
Trichophytosis
What is trichophytosis?
Trichophytosis is a fungal skin disease caused by dermatophytes of the genus Trichophyton (Tr. Mentagrophytes, Tr. Rubrum, Tr. Violaceum, Tr. Verrucosum, Tr. Sconleinii).
What is the cause?
The causative agent is a fungus of the genus Trichophyton characterized by the development of mildly – limited macro and microconidia. Trichophyton rubrum is the most common cause of fungal skin infections in humans.
What does the clinical picture depend on?
The clinical picture varies according to the site of infection and the type of causative agent. On the scalp we distinguish surface foci usually round (single or multiple) where the hair is partially broken and the surface of the foci is covered with grayish scales and deep, inflammatory foci in the form of hemispherical protrusions from which hair falls out, and pus and bloody contents are squeezed under pressure. Deep scalp trichophytosis may be accompanied by fever and enlarged regional lymph nodes. Oval or round red foci of a raised edge on which bubbles and scales may be located are usually seen on bare skin. The surface of the circle widens and can reach several centimeters and the changes may be accompanied by moderate itching.
What is the most common form of trichophytosis?
The most common form of trichophytosis is the athletic foot, which manifests itself in three ways.
The appearance of redness, peeling of moisture and cracking of the skin between the toes, the appearance of dry peeling of the skin of the feet and the appearance of subcutaneous bubbles on the feet.
Who is most often affected?
The disease is more common in men than in women.
What are the preconditions for infection?
The occurrence of the infection is favored by a humid and warm microclimate, wearing rubber clothes, increased sweating of the feet, poor hygiene habits, the use of shared showers and sports locker rooms.
What is prevention?
In the prevention of diseases, it is important to have adequate hygiene habits (regular washing of feet, changing and wearing cotton socks, wearing leather shoes). Patients who have a fungal skin infection on both feet usually have a skin infection in one hand, the one they use more often. This is the so-called “Skin disease of one hand and two feet.”
It is treated like other fungal skin infections with local or systemic therapy.
Epidermophytosis
It is an inflammatory skin disease caused by the dermatophyte epidermophyton floccosum.
Who causes epidermophytosis?
Epidermophyton is a type of fungus that causes superficial fungal infections of the skin. The most common cause is Epidermophyton floccosum, which affects the groin, armpits and nails, and in women the area under the breasts. Epidermophyton infections are more common in men, causing tineu corporis (trunk infection), tineu cruris (itchy feet), tineu pedis (athletic foot), and onychomycosis or tineu unguium fungal infection of the nail bed.
What is the clinical picture?
Sharply demarcated red foci of oval shape, with a slightly raised edge where bubbles and scales can be found, are most often seen in the groin. The central part of the focus is usually pale red, while the edge is more pronounced. It is usually accompanied by severe itching.
How is the diagnosis made?
The diagnosis is made on the basis of the clinical picture, and is confirmed by evidence of the causative agent with a native microscopic preparation and on culture feeders.
How is it treated?
Therapy depends on the localization of the changes and on the clinical picture. For scalp and nail diseases, we use antifungals in the form of tablets (terbinafine, itraconazole, fluconazole and sometimes griseofulvin). If the mentioned drugs are used, it is necessary to control the liver findings in the blood (AST, ALT, GGT). For other forms, preparations in the form of creams or suspensions are used.
Yeast infections
Some fungal infections are caused by yeast.
For example:
Intertrigo
Intertrigo is an infection with the yeast Candida albicans, and affects skin folds. It affects areas of the body that touch each other and where the environment is warm and humid. Such are the armpits, groin, heavy and large breasts or folds of thickness.
Pityriasis versicolor
It is a yeast infection marked by large black spots on pale or tanned skin along with light spots on inflamed or black skin. Another name for this disease is tinea versicolor (versicolor means “in different colors”). It most commonly affects younger people.
Tinea versicolor usually produces several symptoms. Mild itching may intensify when a person becomes hot. Why some people develop tinea versicolor is not entirely clear to us. The yeast that causes tinea versicolor is normally present in small amounts on normal skin. It most often develops in young people.
Diagnosis
Although light or dark-colored spots can be similar to other skin conditions, tinea versicolor can be easily recognized by a dermatologist. To confirm the diagnosis, skin scraping is used in which the presence of yeast is sought under a microscope. A special light called a Wood lamp can also be used. If tinea versicolor is present on the skin, a yellowish green color will appear under the light.
Treatment
Shampoos, soaps, creams or lotions containing selenium sulfide, ketoconazole or zinc pyrithione. Taking oral medications including ketoconazole due to possible side effects or interactions with other medications should be supervised by a dermatologist.
Cold sores (Candida albicans)
The fungus Candida albicans is present in a large number of people and normally lives in the mouth and digestive tract. However, in some cases, such as long-term illness or overuse of antibiotics, the fungi multiply and cause severe symptoms.
Canker sores can affect the mouth and tongue area lined with a mucous membrane such as the vagina or moist wrinkled skin. Aphthous infection usually looks like a small white spot that when rubbed leaves a red mark. In adults, vaginal candidiasis can cause itching and soreness
Candida also occasionally affects men, causing a painful red rash on the glans. White spots of candida can also be seen on the breasts and in the mouth of newborns (oral mycosis). Oral mycosis is usually not serious but can cause throat problems and make feeding difficult. Babies can also develop fungal infections in the diaper region.
Interesting facts
Onychomycosis is a more commonly used term than tinea unguis which includes rare nail infections with yeasts and molds. There are several additional linguistic problems. Tinea inguinalis is usually called tinea cruris but crus in Latin means leaf not groin. Tinea manus is described as an infection of one hand, while tinea manuum is correct when both hands are infected. For feet, the appropriate term is tinea pedis and tinea pedum. For nails, tinea unguium and tinea unguinum are correct.
Ante Perica, MD dermatovenerologist
Keywords: red scaly rash, Trichophiton, Candida, fungal rings on the body, hair loss, canker sores, swimmers, pools
