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Superficial Fungal Infections

Written by
Dr. Mashfika N Alam
and medically reviewed by iCliniq medical review team.

Published on Dec 12, 2017 and last reviewed on Sep 07, 2018   -  6 min read

Abstract

Fungal infections of the skin and mucosal surfaces are very common. There are various types of fungi that affect different areas of the body causing distinct symptoms. Most mild to moderate cases can be treated with topical antifungals whereas severe cases require oral antifungal medications.

Superficial Fungal Infections

Fungal infections of the skin are a very common occurrence in people of all ages, from babies to adults and the elderly, in healthy as well as immunocompromised individuals. There are various types of fungi and each causes distinct features, depending on the site of infection.

Some common types of fungi that affect the human skin are as follows:

1. Dermatophytes or tinea.

2. Candida.

3. Tinea versicolor/ Pityriasis versicolor.

Candida and tinea versicolor are normal flora of the skin but when conditions become suitable, they multiply rapidly, then invade and infect the superficial layer of the skin. They very rarely or never spread into the deeper layers. However, immunocompromised individuals must be careful about them entering the bloodstream and causing severe systemic infections.

Some of the common fungal infections (also called superficial mycoses) according to the site of infection are as follows:

1. Tinea (ringworm):

Species of certain dermatophytes namely, Trichophyton and Microsporum cause infection of the scalp, eyebrows, and eyelashes. They tend to attack the hair shaft and hair follicles.

Symptoms include scaly, raised, and red bumps, broken hair shaft, patches of hair loss, intense itching, redness, and pustules.

Mode of transmission is through contact with affected animals (zoophilic) or humans (anthropophilic). It affects children more commonly than adults.

Treatment includes oral antifungal drugs like Itraconazole, Griseofulvin, etc. Topical antifungals are not effective. However, antifungal shampoo is sometimes prescribed alongside oral medication. Keeping the scalp and hair dry and free of excess sweat and moisture is important in both prevention and treatment of the fungus. Also, affected individuals should not share their towels and hairbrush with others, in order to avoid the spread of infection.

Differential diagnoses are psoriasis, alopecia and sebborheic dermatitis.

It is characterized by red crusted plaques, lumps, and pustules around the beard and mustache areas.

Symptoms include kerion-like plaques, itching, loose hair that can be easily pulled out, redness, pain and pus around lesions.

Mode of transmission is usually through contact with animals (zoophilic) as in case of cattle farmers, and sometimes from humans (anthropophilic). It exclusively attacks adults.

Mild cases can be cured by topical antifungal cream but moderate to severe cases require oral antifungals like Itraconazole, Fluconazole, etc. Men should avoid sharing shaving kit and towels with others particularly in places like the gym, locker rooms or hostels.

Differential diagnoses include alopecia areata and eczema.

It is the dermatophyte infection of the trunk and the extremities. The soles, palms, and scalp are usually spared. It is characterized by ring-shaped or annular red lesions which have a raised, scaly border. Most lesions have an area of central clearing whereas some less common variants tend to have a central zone of hyperpigmentation or raised area of pustules with no central clearing. The latter variant can be confused with psoriasis or erythema multiforme.

Symptoms are red or pink raised annular-shaped plaques or patches with scaly raised border, itching, dry flaky skin around the lesion, loss of hair on affected sites, highly contagious on person to person contact is common.

Topical Miconazole or Clotrimazole cream is generally used to treat it.

Differential diagnoses are erythema multiforme and guttate psoriasis.

This is a dermatophyte infection of the groin and inner thigh folds. The crease around the genitals is commonly affected.

Symptoms include inflamed patches with sharply defined borders that may spread, burning and itching around the lesions. There may be oozing from the borders. This mostly affects adult men but it is not uncommon in women.

Topical antifungal creams such as Clotrimazole or Miconazole is very effective in treating it. Keeping the groin area clean and dry and regular changing of underwear are important preventive measures.

Differential diagnosis is eczema.

This is characterized by red, scaly and itchy patches in the interdigital spaces and soles of the feet.

Symptoms are dry flaky skin, skin cracking and peeling, itching, maceration. It commonly affects young men.

Treatment is usually with topical antifungal creams like Clotrimazole for four to six weeks. Severe cases require oral antifungals like Terbinafine.

Differential diagnosis is eczema.

This dermatophyte infection affects both fingernails and toenails. It affects the nail bed and causes separation of the nail from the nail bed.

The nail turns yellow, hard, and brittle and breaks off.

A mild infection can be treated with a topical antifungal cream, but most cases require oral antifungals like Terbinafine and Itraconazole. A toenail infection with this fungus is difficult to treat and requires treatment for three months.

Differential diagnosis is paronychia.

2. Candidiasis:

Candidal infections are commonly characterized by red itchy rashes.

Depending on the site of infection, the symptoms are red raised rash, intense itching, cracked skin or maceration, dry flaky skin, oozing or discharge.

Common sites of mucocutaneous candidiasis are skin folds like the armpits, neck folds, groin, vagina, oral cavity, anus and perianal region and the nail bed.

Superficial candidiasis has various names on the basis of their site of infection, such as:

Defined by white patches on the surface of the tongue, palate, tonsils, etc., that are difficult to wipe off. Bad breath and loss of taste sensation may be present. It most commonly affects babies and immunocompromised adults.

Differential diagnoses are coated tongue, leukoplakia, and diphtheria.

It is characterized by an itchy whitish vaginal discharge, thick in consistency (cottage cheese appearance) which is usually accompanied by a distinct odor and burning pain during sex and urination. Affects women of all ages.

Differential diagnoses are bacterial vaginosis and chlamydial vaginal infection.

It is characterized by a red raised rash with associated bumps and pustules, frequently. There is skin cracking and oozing too.

Differential diagnoses are eczema and miliaria.

Affects the diaper area, usually the perianal skin. It appears as a raised red rash with red bumps along the edges.

Fungal paronychia is commonly caused by Candida and it affects the nail fold, area under the nail fold and edges around the nail. It is characterized by erythema and swelling surrounding the nail. There is a loss of cuticle and the nail is discolored. Ridges form on the nail plate. People who spend too much time in water or indulge too much in water-related activities like dishwashing are commonly affected.

Differential diagnosis is tinea unguium infection (onychomycosis).

Superficial candidal infections are usually treated with topical antifungal creams like Miconazole, Clotrimazole, etc. Systemic antifungals like Fluconazole may be required in moderate to severe cases.

3. Pityriasis Versicolor/ Tinea Versicolor:

This is a different type of fungus from candida and dermatophytes. This normally lives on the skin but when conditions are favorable, it reproduces rapidly causing a characteristic rash.

The factors that favor the growth of pityriasis versicolor are hot and humid environment or weather, excessive sweating, oily skin and compromised immune system.

Symptoms of infection include a characteristic rash consisting of hypopigmented spots. Smaller spots may coalesce and form patches. These spots may be white pink or brown. They do not tan in the sun. They may be dry, scaly and itchy. It is frequently confused with vitiligo. This most commonly affects the neck, chest, arms and the back. People often come back from holidays wondering why they have white patches on their bodies that did not tan. It is often because of tinea versicolor.

There are three varieties:

The affected spots or patches may lose melanin and become pale or white as in the case of the hypopigmented variant. However, this is usually reversible with treatment.

Pigmentation may take weeks to months to return. In rarer cases, especially if left untreated for a long time, tinea versicolor may lead to irreversible hypopigmented spots. In the hyperpigmented type, melanocytes are affected with pigmented granules resulting in brown patches. In case of the pink variant, there is associated inflammation. The variation in color gives rise to the name 'versicolor'. Diagnosis is based on the clinical examination and the microscopic examination of skin scrapings which may demonstrate the fungus.

Treatment is with topical antifungal creams and in moderate to severe cases, with oral antifungals.

Differential diagnoses include vitiligo, pityriasis alba, pityriasis rosea, postinflammatory hypopigmentation and idiopathic guttate hypomelanosis.

Diagnosis is usually based on the history of symptoms and clinical examination. Skin scrapings and swabs from the mucosal areas can be examined under the microscope to identify the fungus. Fungus from the affected region can also be grown in artificial culture media. However, it is usually hard to grow fungus in artificial media and most of the time, they do not yield any growth leading to false negative results.

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Frequently Asked Questions


1.

Where Do Superficial Fungal Infections Occur?

The superficial fungal infections occur on the superficial layers of the skin. It might include the scalp, nails, and skin. Candida albicans mostly cause it. If the candidiasis infections become severe and enter the blood, then it is known as candidemia.

2.

Is Superficial Fungal Infection Contagious?

Fungal infections are known to be contagious and can spread from one person to another. There are a few types of fungal infections that are not contagious. It is essential to wash your hands after playing with dogs. Maintaining personal hygiene will keep a person away from fungal infections.

3.

What Are Systemic Fungal Infections?

The systemic fungal infections usually begin from the lungs mostly. It can then spread to the other organs. This kind of spreading of the infection to other organs is known as systemic fungal infections. After proper diagnosis, it can be diagnosed with the help of antifungal agents.

4.

What Is a Superficial Candida Infection?

If the superficial infection is caused by candida infection, then it is called superficial candida infections. Dermatophytes and yeasts cause it. Fungal infections usually have a recurrence. These types of fungal infections occur on the hands only in rare conditions. The topical application of Nystatin is known to be beneficial. Medications like Griseofulvin and Itraconazole are also known to be helpful.

5.

What Happens If Fungal Infection Is Left Untreated?

Any type of infection should be treated with care. When it comes to fungal infections, it has to be treated with the same care without ignorance. If the infection is left untreated, it can spread through the skin and result in severe complications. In some patients, it might cause permanent damage such as death. Some infections are known to be contagious, and if it is not treated soon, it can pass to others.

6.

Can a Fungal Infection Affect Your Whole Body?

Some organisms like yeast cause infections in the throat, mouth, and genital organs. They are often harmless and can be treated easily. A few invasive infections can interfere with all the organ systems such as the kidney, heart, and lungs. It is also known to affect the bones, eyes, and brain. It is caused by candida. This type of candidemia is more common in patients who are hospitalized.

7.

Can a Blood Test Detect Fungal Infection?

A blood test is an essential diagnostic tool to identify the presence of fungi in the blood. Some specific tests are very sensitive and will also detect the number of fungi present in the blood. Earlier diagnosis is helpful for faster recovery. It is necessary to check with your doctor before going for blood tests.

8.

How to Cure Fungal Infection on the Skin Naturally?

The topical application of the following can be used to treat skin infections. They are:
- Coconut oil.
- Apple cider vinegar.
- Turmeric powder.
- Aloe vera.
- Garlic paste.
- Tea tree oil.
- Yogurt. Yogurt is known to have good probiotic properties.

9.

What Are Fungal Skin Infections?

Fungal skin infections are also known as mycoses. It can cause visible rashes in the skin. It will be accompanied by redness and itching in the skin. It has to be clinically diagnosed if it is causing a lot of discomfort. Your doctor will prescribe suitable antifungal agents for your condition.

10.

How Long Does a Fungal Infection Last?

The cure for fungal infection depends on the severity of fungal infections. If the infection is very mild, it will get cured very soon. Such infections do not require any treatment. It will take approximately one or two weeks for moderate and severe infections to heal. However, if you make attempts to treat it, then it can be cured sooner.

11.

What Does a Fungal Infection on the Skin Look Like?

A fungal infection on the skin can occur in the skin where there is no proper air circulation. It mostly occurs in sweaty areas. It appears as a reddish or whitish lesion. It is often rounded or irregular in shape. It gives an unpleasant appearance to the skin. It is accompanied by an itching sensation. It appears like blisters in some patients.

12.

What Is the Best Medicine for Fungal Infection?

Topical creams and ointments are known to have better healing properties than oral medications because drugs that are taken orally will take a very long time to show its action. The topical application of Clotrimazole and Ketoconazole are useful in treating fungal infections. They are available in different brand names.

13.

Which Is the Best Antifungal Cream?

The fungal infections can be treated by the following antifungal creams.
- Miconazole cream.
- Clotrimazole cream or lotion.
- Terbinafine cream or gel.
- Zinc pyrithione soap.

14.

Is a Fungal Infection Serious?

A mild fungal infection is not serious. If it is present for a long time, it has to be treated as soon as possible. In untreated cases, the fungal infection can result in severe conditions and can affect the whole body. The common risk factor associated with fungal infection is an immunocompromised state in the patients. The patients who are consuming antibiotic tablets are known to be affected too.

15.

How Do You Get Rid of a Fungal Infection?

The first and the foremost step to get rid of fungal infection is to maintain proper hygiene. You can try some home remedies in the initial stage. If it does not help, then you can go for the topical application of antifungal agents. If you have any underlying medical conditions, you should consult your doctor before taking any medications.

16.

Is Coconut Oil an Antifungal?

Many reports prove that coconut oil works well for fungal infections. It is the best home remedy available. It has good antifungal properties too. For vaginal infections, coconut oil can be applied directly. For infections in the mouth, one or two teaspoons of coconut oil can be taken to swish. It would be helpful to treat mouth ulcers and fungal infections.

Last reviewed at:
07 Sep 2018  -  6 min read

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