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Fungal skin infections

Published by BUPA's health information team, healthinfo@bupa.com, February 2008.

This factsheet is for people who have a fungal skin infection or who would like information about them.

Certain types of fungus, or excessive growth of normally harmless types, cause the symptoms of a fungal skin infection. Most fungal skin conditions can be treated effectively.

What are fungal skin infections
Symptoms
Types of fungal skin infections
Causes
How do fungal infections spread?
Diagnosis
Treatment
Prevention
Sources
Related topics

What are fungal skin infections

Fungal skin infections are infections on your skin caused by a fungus. There are many different types of fungal skin infections.

Symptoms

The symptoms and appearances of a fungal skin infection depend on the type of fungus causing it and the part of the body affected.

They can cause rashes with a variety of different appearances. Some are red, scaly and itchy, whereas others can produce a fine scale similar to dry skin. The fungus may infect just one area of the body, or there may be several infected areas.

Fungal infections of the scalp or beard can lead to hair loss. Fungal rashes can sometimes be confused with other skin conditions, such as psoriasis and eczema.

Types of fungal skin infections

Fungal infections usually affect the skin because they live off keratin, a protein that makes up skin, hair and nails. Fungal skin infections are divided into groups depending on what type of organism is involved. The full name depends on the location of the infection on the body.

Some common fungal infections are listed below.

Dermatophyte infections

Most basic fungal skin infections are caused by dermatophytes - a type of fungi that cause skin, nail and hair infections. They are common, affecting between 10 and 20% of people at some point in their life. They include:

Athlete's foot (Tinea pedis)

This is a very common infection that occurs in one in five adults. It's often caused by a combination of fungi and bacteria. It causes scaling and sogginess of the skin, commonly of the web spaces between the toes. Sometimes the skin becomes pale and can be itchy. The infection is often picked up from contaminated skin fragments in public places, such as swimming pools and shower facilities.

Nail infections

Onychomycosis is the name for any fungal nail infection. Tinea unguium (ringworm of the nails) is a common infection. The nails become malformed, thickened and crumbly. Not all nails affected like this are caused by fungal infections, but it is a common cause. Toenail infections are commonly linked with athlete's foot. Fingernails can be affected too.

Ringworm of the groin (Tinea cruris)

This is called "jock itch" because it occurs in sportspeople. It causes an itchy, red rash in the groin and surrounding area and is commonly seen in men who have been sweating a lot. Often you also have athlete's foot, and scratching your feet followed by the groin may spread the infection.

Ringworm on the body (Tinea corporis)

This affects the body, often in exposed areas like the abdomen or on limbs, causing red patches. They are scaly at the edge with clear skin at the centre. The patches spread out from the centre. It can be caught from domestic animals.

Ringworm of the scalp (Tinea capitis)

This tends to affect young children and can cause hair loss with inflammation in the affected area. It is usually spread from person to person. Most people infected by this fungus don't actually develop the symptoms, but become carriers who can spread the infection to others, sometimes for years.

Yeast infections

Other fungal skin infections are caused by yeast infections. For example:

Intertrigo

Intertrigo is a yeast infection of skin folds caused by Candida albicans. It affects areas of the body that have skin touching skin such as the armpits, groin, and under heavy breasts or fat folds, where the environment is warm and moist.

Pityriasis versicolor

This yeast infection causes increased dark patches on pale or untanned skin and light patches on tanned or darker skin. Another name for this condition is tinea versicolor (versicolor means "of various colours"). Teenagers and young adults are most often affected in the UK.

Thrush (Candida albicans)

The fungus Candida albicans is present in most people, and lives in the mouth and digestive system. It usually lives in harmony with us and rarely causes problems. However, in certain situations, such as during illness or when using antibiotics, the fungi multiply and cause thrush symptoms.

Thrush can affect the mouth and tongue, areas lined with a mucus membrane such as the vagina, and moist, folded skin. Thrush infection often looks like small white patches, which leave a red mark when rubbed off. In adults, vaginal thrush can cause itchiness and a thick, white discharge. For more information, please see Related topics.

Thrush sometimes affects men, causing a painful red rash on the head of the penis (glans). It also commonly affects newborn babies in the mouth (oral thrush). The white patches may be mistaken for breast or formula milk. It isn't usually serious, but babies with thrush in their throats may stop feeding properly. Babies may also develop thrush in the nappy area.

Causes

A number of things can make fungal infections more likely. You're more at risk from fungal infections if you:

have recently taken a course of antibiotics
have been taking oral steroids
have diabetes
are obese
are African-Caribbean
have a history of fungal infections

Moist skin encourages fungal infections. This means fungal infections are more likely when skin isn't dried properly after sweating or bathing, or when it is covered with a material that doesn't allow sweat to evaporate. Damage to the skin surface, such as a cut or graze, can also encourage fungi to grow.

Fungal infections inside the body can cause more serious health problems than those on the skin. These infections only affect people whose immune systems aren't working properly - either as a result of another illness such as AIDS, or because of immunosuppressant medicines, such as those taken after having an organ transplant.

How do fungal infections spread?

Fungal infections can be spread between humans. For example, athlete's foot is thought to be spread in communal areas, such as gyms and swimming pools. Contact with bed sheets or towels can also spread fungal infections.

It's also possible to catch fungal infections from animals such as cats or dogs, and, more rarely, cattle. Ringworm is occasionally caught this way.

Diagnosis

Sometimes fungal infections are easy for doctors to diagnose from the appearance and location of the rash, such as athlete's foot. Sometimes your doctor will take a skin scraping, or a fragment of nail or hair, and send it to the laboratory to confirm the diagnosis.

Treatment

Since most fungal skin infections are surface infections, antifungal treatments are usually applied directly to the skin in the infected area (topical treatments).

There are a variety of treatments available in the form of creams, lotions and medicated powders. If the rash covers quite a large area of skin, or affects the nails or scalp, then tablets may be required.

Some treatments are available over-the-counter from a pharmacist, without a prescription. For example, sprays are available for treating athletes foot. Ask your pharmacist for advice.

Stronger forms of topical treatments and antifungals in tablet form are only available on prescription. You may also be prescribed antifungal shampoo for scalp infections.

These treatments are usually effective. Like any drug, they can occasionally cause side effects. These may include skin irritation or an upset stomach. It isn't unusual for the rash to return, even when it seems to have been treated. The treatment may need to be used for at least four weeks to prevent the infection from coming back.

If you are buying an over-the-counter antifungal treatment, you need to be sure that you have a fungal infection. You may recognise the rash from a previously diagnosed fungal infection. But if there's any doubt about your diagnosis, or if over-the-counter treatments don't work, then you should seek advice from your GP.

Prevention

Taking the steps listed below may help to reduce the risk of getting a fungal infection.

Dry your skin carefully after bathing.
Wear loose fitting clothes and underwear.
Avoid sharing towels, hair brushes, and combs, which could contain skin fragments that harbour fungal colonies.
Change socks or tights daily.
For athlete's foot, alternate shoes every two or three days so that they have time to dry out.
Choose fabrics that allow the skin to "breathe" - natural fibres such as cotton are better than nylon or polyester for underwear.
For sportspeople, synthetic fibres that "wick" the sweat away from the body, helping to keep the skin dry, may be preferable.
If you have diabetes you need to keep good control of your blood sugar (for more information see the BUPA factsheets on Type 1 and Type 2 Diabetes).

Sources

Fungal (dermatophyte) skin infections. Clinical Knowledge Summaries.
http://cks.library.nhs.uk
accessed 30 March 2007
Simon, C, Everitt, H, and Kendrick, T, Oxford handbook of general practice. Oxford: Oxford University Press, 2005: 672-673
Candida. Clinical Knowledge Summaries.
http://cks.library.nhs.uk
accessed 29 March 2007
British National Formulary, BNF 52,: BMJ Publishing Group Ltd and RPS Publishing, 2006