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Cutaneous fungal infection

Background knowledge ๐Ÿง 

Definition

  • Cutaneous fungal infections, also known as dermatomycoses, are infections of the skin caused by fungi
  • Commonly caused by dermatophytes, yeasts, and molds
  • Examples include tinea infections, candidiasis, and pityriasis versicolor

Epidemiology

  • Common worldwide, affecting all age groups
  • Higher prevalence in warm, humid climates
  • Risk factors include immunosuppression, diabetes, and poor hygiene
  • Occupational exposure in certain professions (e.g., athletes, agricultural workers)

Aetiology and Pathophysiology

  • Dermatophytes: Trichophyton, Microsporum, Epidermophyton
  • Yeasts: Candida species, Malassezia furfur
  • Molds: Aspergillus species
  • Fungi invade keratinized tissues (stratum corneum, hair, nails)
  • Transmission through direct contact with infected individuals, animals, or fomites
  • Moist, warm environments promote fungal growth

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Itching and irritation
  • Red, scaly patches on the skin
  • Rings of red, inflamed skin (tinea corporis)
  • White or yellowish thickened nails (onychomycosis)
  • White or brown patches on the skin (pityriasis versicolor)
  • Maceration and fissuring in intertriginous areas (candidiasis)

Signs

  • Erythematous, scaly lesions
  • Annular plaques with central clearing (tinea)
  • Thickened, discolored nails
  • Hypo- or hyperpigmented macules (pityriasis versicolor)
  • Satellite pustules in intertriginous areas (candidiasis)
  • Kerion formation in severe tinea capitis

Investigations ๐Ÿงช

Tests

  • Clinical diagnosis based on appearance and history
  • Skin scrapings for microscopy and culture
  • KOH preparation to visualize fungal elements
  • Wood’s lamp examination for certain infections (e.g., tinea versicolor)
  • Nail clippings for onychomycosis diagnosis
  • Biopsy in atypical or refractory cases

Management ๐Ÿฅผ

Management

  • Topical antifungals: Clotrimazole, miconazole, terbinafine for localized infections
  • Oral antifungals: Terbinafine, itraconazole, fluconazole for extensive or refractory infections
  • Keep affected area clean and dry
  • Avoid sharing personal items to prevent spread
  • Regular monitoring for side effects of oral antifungals
  • Follow UK guidelines (e.g., NICE) for specific treatment protocols

Complications

  • Secondary bacterial infection
  • Chronic or recurrent infections
  • Scarring and post-inflammatory pigmentation changes
  • Systemic spread in immunocompromised individuals
  • Adverse effects from long-term antifungal therapy
  • Psychosocial impact due to cosmetic concerns

Key points

  • Cutaneous fungal infections are common and vary in presentation
  • Diagnosis is usually clinical, supported by microscopy and culture
  • Management includes topical and oral antifungals depending on severity
  • Preventive measures are crucial to avoid recurrence
  • Follow UK guidelines (e.g., NICE) for treatment recommendations
  • Monitor for complications and recurrence

References

  • BNF – British National Formulary (https://bnf.nice.org.uk/)
  • NHS Inform – Fungal skin infections (https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/fungal-skin-infection)
  • BMJ Best Practice – Fungal skin infections (https://bestpractice.bmj.com/topics/en-gb/1042)

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