Superficial Fungal Infections : Description, Cause, Management and Advice For Patient
Description
● A common and mild infection of the superficial layers of the skin, nails and hair, but can be severe in immune compromised individuals
Cause
● Three main groups: dermatophytes (tinea/ringworm), yeasts (e.g. candidiasis, malassezia), moulds (e.g. aspergillus)
Presentation
● Varies with the site of infection; usually unilateral and itchy
● Tinea corporis (tinea infection of the trunk and limbs) - Itchy,circular or annular lesions with a clearly defined, raised and scaly edge is typical
● Tinea cruris (tinea infection of the groin and natal cleft) – very itchy, similar to tinea corporis
● Tinea pedis (athlete’s foot) – moist scaling and fissuring in toewebs, spreading to the sole and dorsal aspect of the foot
● Tinea manuum (tinea infection of the hand) – scaling and dryness in the palmar creases
● Tinea capitis (scalp ringworm) – patches of broken hair, scaling and inflammation
● Tinea unguium (tinea infection of the nail) – yellow discolouration, thickened and crumbly nail
● Tinea incognito (inappropriate treatment of tinea infection with topical or systemic corticosteroids) – Ill-defined and less scaly lesions
● Candidiasis (candidal skin infection) – white plaques on mucosal areas, erythema with satellite lesions in flexures
● Pityriasis/Tinea versicolor (infection with Malassezia furfur) – scaly pale brown patches on upper trunk that fail to tan on sun exposure, usually asymptomatic.
Management
● Establish the correct diagnosis by skin scrapings, hair or nail clippings (for dermatophytes); skin swabs (for yeasts)
● General measures: treat known precipitating factors (e.g. underlying immunosuppressive condition, moist environment)
● Topical antifungal agents (e.g. terbinafine cream)
● Oral antifungal agents (e.g. itraconazole) for severe, widespread, or nail infections
● Avoid the use of topical steroids – can lead to tinea incognito
● Correct predisposing factors where possible (e.g. moist environment, underlying immunosuppression)
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