Fungi and Disease
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Fungi in Hospitals
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Fungi in Food
Aspergillus

Blastomycosis
Introductory Article
My Blastomycosis Story
Fatal Brain Infection
Dr. G's 2 slide culture
Blastomycosis Images
Blastomycosis Medical Literature
Reflections on an Illness

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Fungal infections of the skin, hair and nails

Fungal Skin Infections

Fungi are found everywhere and yeasts form part of the normal skin flora. Fungal infections of the skin, hair and nails are common skin diseases. Fungi can infect the skin of people of all ages. Increased incidence occurs in immunocompromised patients who have AIDS or are being treated with chemotherapeutic agents and therapy directed at reducing inflammation. People with diabetes and people who are simply getting older have more infections.

Skin infections can be divided into the most common superficial group that stays in the outer layers of the skin and an invasive group that extends beyond the skin in adjacent tissues and spread to other organs. Invasive skin infections such as blastomycosis often develop after a primary lung infection is established. The infecting yeast travel in the blood from the lung to skin areas. See Blastomycosis of the Skin.

Candida

Candida infection occur in damp areas, in any skin fold, in the groin, around the anus and vagina. The skin becomes itchy, painful and red. Women  often develop candidal vulvovaginitis with white plaques developing inside on a swollen, red vaginal mucosa with a creamy vaginal discharge; The surrounding skin becomes red and sore; sometimes pustules develop on the vulvar skin.  Male sex partners often develop skin infections involving the penis, scrotum and groin.

Candida can infect nails and the tissue surrounding the nail (paronychia).  Swelling with pain of the nail fold can become chronic with nail involvement. The nail develops yellowish discoloration and may separate from the nail bed.
More about Candida

Malassezia Infections

Malassezia includes nine species, eight of which have been recovered from humans.

Tinea versicolor (pityriasis versicolor) is a yeast infection that changes the pigmentation of the skin but is otherwise assymptomatic. Blotches of darker skin in light-skinned patients; areas of light pigmentation appear in patients with dark skin. The yeasts also can grow in hair follicles causing inflammation with red papules and pustules that surround individual hairs. Treatment with selenium sulfide shampoo (Selsun) is usually helpful. The shampoo is applied to the affected skin and allowed to dry for 15 minutes and then washed off. This routine can be repeated weekly as required to prevent recurrence. Seborrheic dermatitis involving the scalp causes dandruff and may be a lifelong problem that can be controlled with regular use of selenium sulfide shampoo and/or Nizoral shampoo.

Dermatomycoses  are caused by filamentous fungi such as Trichophyton, Microsporum or Epidermophyton.

Tinea pedis is fungal infection of the feet (athletes foot), the most common skin fungal infections that  affect 70% or more of the adult population worldwide.

Tinea capitis is a scalp infection with trichophyton tonsurans and violaceum or  microsporum canis, primarily affecting prepubescent children.

Tinea gladiatorum was named after fungal infections of the face, neck and shoulders become common in high school wrestlers. often caused by Trichophyton tonsurans.

Ringworm infections (tinea corporis and tinea cruris).  There are expanding ring lesions, not caused by worms. Fungi infect  the skin. Tinea corporis is usually a scaly plaque with a red ring border and central clearing; this is caused by Trichophyton rubrum, Trichophyton tonsurans, Trichophyton mentagrophytes and Microsporum canis. The fungus can be transmitted from other humans, cats and dogs. Trichophyton rubrum may first infect the feet and spread to other parts of the body.

Onychomycosis is a fungal infection affecting the nail bed and nail plate requires treatment with oral antifungal agents. Toenails are more often involved than finger nails. White crumbly areas on the nail surface, (T. mentagrophytes) and abnormal color are the main signs of infection. Nail involvement often accompanies skin fungal infection.

Treatment

Some fatty acids are toxic to fungi. Undecanoic acid, an eleven carbon fatty acid, is most toxic to fungi growing in culture and has been available for many years as a treatment for skin fungal infections (as Desenex).

Three types of inhibitors of the ergosterol biosynthetic pathway are effective in suppressing the growth of skin fungi:

1 Azoles (e.g. topical miconazole and topical/oral ketoconazole, itraconazole and fluconazole)
2. Allylamines (e.g. terbinafine)
3 Morpholines (amorolfine).

A Cochrane review of topical skin treatment for fungal infection concluded that allylamines, azoles and undecenoic acid were efficacious. Allylamines cure slightly more infections than azoles but are much more expensive. The most cost – effective strategy is first to treat with azoles or undecenoic acid and to use allylamines only if that fails.

Skin infection with blastomycosis.

Early lesions are nonpainful papules, nodules, or plaques that develop drainage areas in the  middle of the lesion. In immunocompromised patients multiple acute pustular lesions  appear in the context of an acute systemic illness. Disseminated blastomycosis can appear in any part of the body: prostatitis, peritonitis, osteomyelitis, septic arthritis, laryngeal and brain involvement have been reported.

Azole Drug Example 

Miconazole nitrate is used topically for the treatment of tinea pedis, tinea cruris, and tinea corporis caused by T. mentagrophytes, T. rubrum, or Epidermophyton floccosum and for the treatment of cutaneous candidiasis (moniliasis). Tinea corporis and tinea cruris generally can be effectively treated using a topical antifungal; however, an oral antifungal may be necessary if the disease is extensive, dermatophyte folliculitis is present, the infection is chronic or does not respond to topical therapy, or the patient is immunocompromised because of coexisting disease or concomitant therapy. While topical antifungals usually are effective for the treatment of uncomplicated tinea manuum and tinea pedis, an oral antifungal usually is necessary for the treatment of hyperkeratotic areas on the palms and soles, for chronic moccasin-type (dry-type) tinea pedis, and for the treatment of tinea unguium (onychomycosis).

Topical agents available as non-prescription self medications include: miconazole, clotrimazole, terbinafine, tolnaftate, naftifine, ciclopirox, ketoconazole, econazole, oxiconazole, butenafine, or sulconazole.

Fungal skin infections and other common disorders are discussed in the the book,
Skin in Health and Disease by Stephen Gislason MD.

Skin in Health and Disease

References

Hirschmann, Jan V, 2 Dermatology, VII Fungal, Bacterial, and Viral Infections of the Skin, ACP Medicine Online, Dale DC; Federman DD, Eds. WebMD Inc., New York, 2000. http://www.acpmedicine.com/
Gupta AK ; Cooper EA ; Ryder JE ; Nicol KA ; Chow M ; Chaudhry MM. Optimal management of fungal infections of the skin, hair, and nails. Am J Clin Dermatol.  2004; 5(4):225-37 (ISSN: 1175-0561)
Borgers M ; Degreef H ; Cauwenbergh G. Fungal infections of the skin: infection process and antimycotic therapy. Curr Drug Targets.  2005; 6(8):849-62 (ISSN: 1389-4501)
Crawford F ; Hart R ; Bell-Syer S ; Torgerson D ; Young P ; Russell I. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev.  2000; (2):CD001434 (ISSN: 1469-493X)

 

 

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