Fungi normally occur on the human skin in balance with other micro-organisms. These together constitute the normal flora of skin and protect skin from harmful germs. Many fungal infections happen due to disruption of the normal flora. Many fungi are capable of invading the skin and nails. Mostly these remain limited to skin and mucosa. They may extend more deeply into the organs in people having low immunity due to any reason like antibiotic use, AIDS, cancers, steroid use, burns etc. We can broadly classify these infections into superficial skin infections and deeper infections.

 

Superficial fungal infections of skin are most common of all skin infections. These are often caused by overgrowth of normal flora associated with a change in environment of skin. The causative organism is either a dermatophyte, candida or Malassezia furfur. Dermatophytes infect keratinized cells of skin, hair follicles and nails. These cause symptoms of tinea, frail nails, dry scales, peeling, fissures. Dermatologist may check the scrapings under a microscope or Wood’s lamp to confirm diagnosis. Candida shows up as itching, smelling, white rash on skin or curd like discharge from mucosa. Moisture exacerbates the symptoms of Candida. Diaper rash is a typical example of Candida infection caused due to excessive humid skin. Malassezia furfur causes dandruff of scalp and can recur despite treatment. These infections are usually harmless and patients seek treatment mostly for cosmetic reasons or annoyance from the rash. Dermatologist uses his experience to determine if the topical anti-fungal medicines will suffice or oral anti-fungal medicines are needed.

Deeper fungal infections of skin such as mycetoma, chromomycosis and sporotrichosis can happen after inoculation from outside e.g prick of a rose thorn can cause sporotrichosis.  Fungal lung infections can spread deeper into other organs including skin from lungs e.g Cryptococcus, histoplasmosis, coccidioidomycosis, penicillinosis. Low immunity plays a big role in these deeper infections. Candidemia (blood infection due to Candida) is the fifth most common cause of getting infection from a hospital. These require oral and intravenous antifungals. Due to low immunity, people may get infected from fungi in air, water or food. Despite extensive treatment the patient with deeper fungal infection may suffer complications including death.

Diagnosis can be facilitated by microscopic examination of the scrapings from the associated skin infection or affected tissues.

Mainstay of treatment is to avoid the cause, raise immunity with lifestyle measures and topical anti-fungal medicines like clotrimazole and nystatin. In deepar and systemic fungal infections, it is usually suggested to breathe in cleaner air and drink cleaner water. It is a well-known fact that once a patient is given oral anti-fungal medicines, he will require them for the rest of his life. These can cause frequent side effects. Therefore, antifungal medicines need to be taken after due consideration of many factors like overall health and survival expectancy of the person and efficacy and safety of the medicine.

Ask A Dermatologist to confirm the diagnosis and need for appropriate treatment.

 

Written by - Dr Vaishalee Punj