fungus on the skin

Fungus on the skin

Most of the diseases in the world are spread due to dirt and environmental population. Today we will talk about a skin disease that is directly related to cleanliness. 

Most people do not pay attention to this skin disease at the beginning. It spreads very quickly to the patient's skin. We are talking about skin fungal infections.

Fungal (mycoses ) skin infection 

Fungal (Mycotic) infections are traditionally divided into two groups, superficial and deep. In this article, we will discuss only the superficial infections.

The diagnosis of fungal infections of the skin is usually based on the location & characteristics of the lesions.

Since most skin favours the growth of fungi, dry the skin carefully after bathing or after perspiring heavily. Talc or other drying powders may be useful. 

The use of topical corticosteroids for other diseases may be complicated by intercurrent tinea infection, and topical antifungals are often used in intertriginous areas with corticosteroids to prevent this.

Common types of fungal skin infections

1. Tinea Corporis  (Body Ringworm):

It has nothing to do with a worm; they are called worm just because of its shape. Ring-shaped lesions with an advancing scaly border and central clearing or scaly patches with a distinct border.On exposed skin surfaces or the trunk. 

The lesions are often on exposed areas of the body, such as the face and arms. Microscopic examination of scrapings or culture Confirms the diagnosis.

Symptoms and Signs:

The most common itching occurs at night. Itching may be present. In classic lesions, rings of erythema have an advancing scaly border and central clearing.

 Prevention:

Treat infected household pets (Microsporum infections). To prevent recurrences, the use of foot powder and keeping feet dry by wearing sandals, or changing socks can be useful.

 Treatment:

Body ringworm usually responds promptly to conservative topical therapy or to an oral agent within 4 weeks. 

Tinea corporis responds to most topical antifungals, including miconazole, clotrimazole, butenafine, and terbinafine, which are available over the counter. Terbinafine and butenafine require shorter courses and lead to the most rapid response. Treatment should be continued for 1-2 weeks after clinical clearing.

Griseofulvin (ultra micro size), 250-500 mg twice daily, is used. Typically, only 4-6 weeks of therapy are required. Itraconazole as a single week-long pulse of 200 mg daily is also effective in tinea corporis. Terbinafine, 250 mg daily for 1 month, is an alternative.

2. Tinea Cruris (Jock Itch):

Marked itching in intertriginous areas, usually sparing the scrotum. Peripherally spreading, sharply demarcated, centrally clearing erythematous lesions. May have associated tinea infection of feet or toenails. Tinea cruris lesions are confined to the groin and gluteal cleft. 

Symptoms and Signs Itching may be severe, or the rash may be asymptomatic. The lesions have sharp margins, cleared centres, and active, spreading scaly peripheries. Follicular pustules are sometimes encountered, The area may be hyperpigmented on the resolution.

Tinea cruris must be distinguished from other lesions involving the intertrigo geginous areas, such as candidiasis, seborrheic dermatitis, intertrigo, psoriasis of body folds (" inverse psoriasis"), & erythrasma.

 Prevention:

The essential factor in prevention is personal hygiene. Wear open-toed sandals if possible. Careful drying between the toes after showering is essential. A hairdryer used on low setting may be used.

 Socks should be changed frequently, and absorbent non-synthetic socks are preferred. Apply to dust and drying powders as necessary. The use of powders containing antifungal agents (eg, Zeasorb-AF) or chronic use of antifungal creams may prevent recurrences of tinea pedis.

* Treatment :

Tinea cruris usually responds promptly to topical or systemic treatment, but often recurs. Drying powder (eg, miconazole nitrate [Zeasorb-AF]) can be dusted into the involved area in patients with excessive perspiration or occlusion of the skin due to obesity. 

Any of the topical antifungal preparations  Terbinafine creams is curative in over 80% of cases after once-daily use for 7 days.

Griseofulvin Ultra micro size is reserved for severe cases Give 250-500 mg orally twice daily for 1-2 weeks. One week of either itraconazole, 200 mg daily, or terbinafine 250 mg daily, can be effective.

3.Tinea pedis (Tinea Manuum )

Fungal infections on legs and hands are called tinea pedis. Most often presenting with asymptomatic scaling. May progress to fissuring or maceration in toe web spaces.Common cofactor in lower leg cellulitis.

Itching, burning and stinging of interdigital web scaling palms, and soles; vesicles of soles inflammatory cases. The fungus is shown in skin scrapings examined microscopically or by a culture of scrapings.

Tinea of the feet is an extremely common acute or chronic dermatosis. Most infections are caused by Trichophyton species. The presenting symptom may be itching, burning, or stinging. The KOH (Potassium hydroxide) preparation is usually positive.

* Prevention

The essential factor in prevention is personal hygiene. Wear open-toed sandals if possible. Careful drying between the toes after showering is essential. A hairdryer used on low setting may be used. 

Socks should be changed frequently, and absorbent non-synthetic socks are preferred. Apply to dust and drying powders as necessary. The use of powders containing antifungal agents (eg, Zeasorb-AF) or chronic use of antifungal creams may prevent recurrences of tinea pedis.

 Dry condition 

Use any of the antifungal agents. The addition of urea 10-20% lotion or cream may increase the efficacy of topical treatments in thick ("moccasin") tinea of the soles.

Systemic measures 

Griseofulvin may be used for severe cases or those recalcitrant to topical therapy. If the infection is cleared by systemic therapy, the patient should be encouraged to begin maintenance with topical therapy, since recurrence is common. 

Itraconazole, 200 mg daily for 2 weeks or 400 mg daily for I week, or terbinafine, 250 mg daily for 2-4 weeks, may be used in refractory cases.

Macerated stage 

Treat with aluminium subacetate solution soaks for 20 minutes twice daily. Broad-spectrum antifungal creams and solutions (containing imidazoles or ciclopirox instead of tolnaftate and haloprogin) will help combat diphtheroids and other gram-positive organisms present at this stage and alone may be adequate therapy. 

If topical imidazoles fail, 1 week of once-daily topical allylamine treatment (terbinafine or butenafine) will often result in the clearing.

Treatment 

A diagnosis should always be confirmed by KOH preparation, culture, or biopsy. Griseofulvin is safe and effective for treating dermatophyte infections of the skin (except for the scalp and nails.

 Itraconazole, an azole antifungal, and terbinafine, an allylamine oral antifungal, have excellent activity against dermatophytes and can be used in shorter courses than griseofulvin. Fluconazole has excellent activity against yeasts and maybe the treatment of choice.

 

4.  Tinea Versicolor (Pityriasis Versicolor) :

Vitiligo usually Presents with larger periorificial lesions. Vitiligo (and not tinea versicolor) is characterized by total depigmentation. Velvety, tan, or pink macules or white macules that do not tan.Fine scales that are not visible but are seen by scraping the lesion.

Central upper trunk, the most frequent site. Yeast and short hyphae observed on microscopic examination of scales. Tinea versicolor is a mild, superficial Malassezia infection of the skin (usually of the upper trunk). 

Symptoms  

Lesions are asymptomatic, but a few patients note itching. The lesions are velvety, tan, pink, or white macules that vary from 4 to 5 mm in diameter to large confluent areas. Large, blunt hyphae and thick-walled budding spores (spaghetti and meatballs") are seen on KOH.

* Treatment

Topical treatments include selenium sulfide lotion, which may be applied from neck to waist daily and left on for 5-15 minutes for 7 days; this treatment is repeated weekly for a month and then monthly for maintenance.

Ketoconazole shampoo, 1% or 2%, lathered on the chest and back and left on for 5 minutes may also be used weekly for treatment and to prevent a recurrence. Ketoconazole, 200 mg daily orally for 1 week or 400 mg as a single oral dose, with exercise to the point of sweating after ingestion, results in the short-term cure of 90% of cases. 

Patients should be instructed not to shower for 8-12 hours after taking ketoconazole because it is delivered in sweat to the skin. Risk of drug-induced hepatitis. Two doses of oral fluconazole, 300 mg, 14 days apart have similar efficacy.

In fungal infection don't used to try tight and thick clothes. Exercise properly, eat a balanced diet, live a healthy lifestyle. It is the dermatologist or skin specialist's job to tell it is a fungal infection or not. Self -medication can make the disease worse.