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Medical Dermatology

Fungal Infections

What is a fungal infection?

Fungal infections are caused by an overgrowth of the body’s normal fungal flora (part of the body’s microbiome.)  Fungi love warm, moist body surfaces including between toes, toenails, genitals, groin and under the breasts. They are caused by yeasts called Candida or Malassezia, or by dermatophytes (ringworm or tinea). Fungal infections can be contagious and typically appear as red, scaly, itchy patches with central clearing. Infection with a yeast or dermatophyte can also cause a rash on an area of the body that is NOT infected.  This is due to an allergic reaction to the fungus and is called an id reaction. Topical and oral antifungal medications are the treatment.

About Candida Infections

Yeasts live on the skin and most don’t cause rashes.   Candida lives on the skin, in the mouth, in the digestive tract, in an uncircumcised penis, and the vagina. It usually causes no problems unless it overgrows on the mucous membranes and moist skin of the groin, armpits, between the fingers and toes, under the breasts and the nails. Common symptoms include rash, blisters that ooze clear fluid, itching and burning.

What are Candida symptoms?

Symptoms vary depending on the location of the infection. For example, vaginal candidiasis causes a white or yellow heavier discharge from the vagina that burns itches and causes redness. Candida in skin folds appears as a bright red rash with blisters and burns and itches. Thrush is Candida of the mouth that causes white patches in the tongue and inside the cheeks which can be scraped off and may bleed. In adults, thrush is a sign of a weak immune system. In the fingers and toes Candida causes painful redness and swelling around the nail, and in the worst cases may grow under the nail and cause it to turn white or yellow and lift.

What are Candida risk factors?

The conditions must be right to enable a candida infection. Conditions include hot, humid weather, tight synthetic underwear, poor hygiene, and infrequent diaper change or undergarment change in children and the elderly. Yeasts are common in people that have a lot of skinfolds, and people with diabetes who are more susceptible to fungal infections. People who take antibiotics can develop Candida because the antibiotics kill the bacteria that keep the yeast from overgrowing. Drugs and therapies that suppress the immune system increase the risk of candida.

How is a yeast infection diagnosed?

Yeast infections are diagnosed by clinical exam or by skin scaping or cultures. The scaping is examined under a microscope or grown in a culture.  Antifungal medications applied topically are the treatment of choice. If needed, antifungals can be taken by mouth as well. Self-care includes keeping the affected areas dry. When inflammation and itching are a problem, corticosteroids may be prescribed to help with symptomatic relief.

About Dermatophytes

Dermatophytes are molds (a kind of fungi) that feed on keratin, a protein that makes up the outer layer of skin. Dermatophytes live on the skin, hair and nails. Some dermatophytes live on the skin and never cause an infection. When they do it is usually because the affected area has a poor blood supply, or the immune system is suppressed. However, fungi can be picked up in locker rooms, public bathrooms and showers, and swimming pools, as well as from wearing tight shoes and sweaty socks.

What are Dermatophyte Symptoms?

Symptoms depend on the area infected and usually include itching, scaling and a raised border with little inflammation. The infected skin patches can come and go. When inflamed, the infection may produce fluid filled spots that ooze.

Which infections are caused by Dermatophytes?

Dermatophytes cause:

  • Fungal infections with ringworm produce rashes, scaling and itching. Ringworm is not caused by a worm but is named based on the ring shape of the skin lesions.
  • Athlete’s foot is a yeast infection. The yeast feed on dead skin, hair and nails. It causes peeling, cracking and scaling, blisters, burning and itching between the toes.
  • Jock itch is caused by a dermatophyte in the groin and appears as a red, itchy, raw-appearing rash
  • Scalp ringworm or tinea capitis is a dermatophyte infection of the hair follicles.

How is a Dermatophyte Infection Diagnosed and Treated?

Diagnosis is by visual exam, scrapings and sometimes cultures of scrapings. Treatment involves the use of antifungal drugs applied topically or taken orally. Steroids may be recommended to relieve itching and inflammation.

When you live in the Asheville, North Carolina area, and develop an itchy red rash, contact our office to schedule a consultation to receive the correct diagnosis and treatment.


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