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Fungal Infections

Fungal or mycotic infections may occur in many different areas of the body- on the feet or between the toes, in the groin, on the torso, hands, face or scalp. They are caused by many different types of fungi – a table of the varying groups and the conditions they cause is given below.

Fungi may spread from one area of the body to another and may originate from animals such as an infected cat or dog, (which will also need treatment if this is the case) and from contact with other people directly or indirectly. Tinea may be picked up from wet floors in public showers. People who perspire freely or have their hands frequently in water are more often affected, as fungi grow in moist, warm conditions.Inflamed or otherwise damaged skin is more easily infected.

Tinea Capitis
Tinea capitis is simply ringworm of the scalp. In this condition the fungus invades the hair shaft. Tinea capitis is characterised by inflammation of the scalp with varying degrees of crusting and scaling. Hair loss results as well as broken abnormal hair stumps. This condition is rarely seen in pharmacy and is generally treated by medical practitioners.

Tinea Barbae
Tinea barbae is ringworm of the beard and moustache areas of the face. This infection is characterised by inflammation, papules and pustules surrounding the hairs on the face and neck.

Tinea Corporis, Tinea Faciei
Ringworm of the body or face is characterised by sharply defined circular lesions. There is usually a raised red border of blisters with clearing in the centre of the lesion. The affected skin may be itchy. Single or multiple lesions may occur. This infection is usually transferred from an active lesion on an animal or another person.

Tinea Cruris
This is a common infection, and is more frequent in males than females. However, it may occur in both sexes and extend backwards to the anal area and area between the buttocks. The patches of skin are often surrounded by a sharply defined outline. The degree of inflammation varies; the colour ranges from almost normal skin colour to tan to bright red. An intense itching is often present. A Candida albicans (thrush) infection may occur as a secondary infection. The skin of this area may also be affected by seborrhoeic dermatitis, psoriasis and eczema.

Any condition which is severe or is not responding to treatment should be referred for medical attention.

Tinea Pedis (Athlete’s Foot)
Tinea of the feet: The skin on the sole of the foot looks moccasin-likein appearance and is dry and peeling. Between the Toes: The skin is initially peeling and itching, and may become cracked and soggy due to the moisture and warmth. The affected skin is often itchy. Secondary bacterial infection is frequent. Candida albicans is also likely to be present in fissures which are soggy and macerated.

Tinea Manuum
Tinea of the hands usually presents as redness and scaling of the palms. The cause may be from an infected animal (cat or dog), which if this is the case, will also need treatment. The arms, neck, upper part of the chest and cheeks may also become affected from touching by the hands. If the flesh at the base of the thumb is affected, the ringworm will take longer to eradicate as the flesh is thicker here, and a stronger preparation is likely to be needed.

Pityriasis Versicolor
Pityriasis versicolor is characterised by patches of opposite coloured skin – white on a sun-tanned or dark skin, coffee-colored on a pale skin. This infection usually occurs on the body and may spread to the neck or face.

Paronychia, Onychia
The folds of skin surrounding the nails often become infected especially in those who have their hands constantly in water, e.g. nurses, bar attendants. The nail folds become red and inflamed. The nails themselves are sometimes infected and become discoloured. Bacteria also invade the affected area. The Candida species of fungi are frequently involved in moist skin-fold infections.

Thrush, Candidiasis, Monilia
Thrush, sometimes known as monilia or candidiasis, is usually caused by a yeast-like fungus, Candida albicans, but occasionally by other types of Candida. Candida albicans is normally present in the bowel, where it does no harm. Candida albicans tends to increase after the use of antibiotics and other imbalances of the environment, due to a decrease in the bacteria which normally control the growth of Candida albicans. It is sometimes also present in the vagina. Pregnancy, the use of oral contraceptives and uterine devices increase the chance of Candida albicans infections.

People whose immunity is lowered by drugs or disease, or who suffer from diabetes, are also more vulnerable. Candidaalbicans may also be present in the napkin area of infants, or in the mouths of newborn babies where white patches of skin may be seen and for which medical attention is necessary. Candida albicans tends to infect skin or mucous membrane which is already inflamed, particularly in warm moist areas such as the groin, the vulvovaginal area or under the breasts.

Vulvovaginal Candidiasis
The symptoms of vulvovaginal candidiasis include erythema and inflammation, intense itching and soreness and a creamy-white discharge.

Candida Balanitis
A Candidal infection of the penis may occur in the sexual partner of a female with vulvovaginal candidiasis. This infection is also common in elderly males and in cases of diabetes mellitus. The symptoms include small white thin-walled pustules on the glans. Inflammation and erythemaare usually present.

Napkin Candidiasis
Rashes in the napkin area may become secondarily infected with Candida. The skin will usually be red and inflamed. Candida can be diagnosed by the appearance of small white pustules around the edges of the rash.

It is important to note that, as bacteria are nearly always associated with fungal infections, the anti-fungal product used should also be anti-bacterial. It should also be effective against the organism Candida albicans, which frequently causes a superimposed monilial or thrush infection in warm, moist areas, where inflammation is already present, such as in the groin, the vulvovaginal area or under the breasts.

Candida albicans may also be present if the skin is soggy and macerated between the toes or fingers. To ensure that the fungal infection is completely and effectively treated and to help prevent recurrence it is important to continue the treatment for at least 5 days after the initial symptoms have disappeared. Soap should be avoided as it may cause further irritation to the skin. A soap alternative should be recommended.

Advice for the Patient

Careful drying of the skin and early treatment of the condition to prevent its spread to other areas is essential. The wearing of airy, absorbent clothing, light open shoes or sandals and the avoidance of overheating, rubber-soled shoes and synthetic socks will also help.

Products to Help (Soap Alternatives, Anti-pruritics)

RESOLVE PLUS 1.0
Contains miconazole nitrate and 1.0% hydrocortisone for the treatment of inflamed fungal skin infections not responding to other anti-fungal treatments. Resolve Plus 1.0% works by treating the inflammation of the fungal infection and reducing the irritation caused by moisture and inflammation at the site of infection. Studies have shown cure rates of up to 90% when using miconazole and hydrocortisone together*

* Faergemann J (1986) Seborrhoeic dermatitis and Pityrosporum orbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole – hydrocortisone (Daktacort), miconazole and hydrocortisone. British Journal of Dermatology 114:695-700

Products to Consider