Cutaneous fungal infections

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What is it about ?

Skin fungi or dermatomycosis are diseases of the skin and mucous membranes caused by fungi. Fungi are very widespread in nature: in gardens, in animals, in humans, and even quite simply in the air … You are not necessarily infected as soon as you come into contact with a fungus. In fact, infections are even rather rare. In the case of athlete’s foot yeast infection, a yeast infection of the foot, hereditary factors may play a role. In contrast, fungi are easily transmitted from animals to humans. Human-to-human transmission is also possible. Sometimes the infection affects skin that is already damaged (for example by small wounds), but it can also affect healthy skin.

What is their frequency?

Yeast infections are very common.

How to recognize them?

  • The yeast infection or athlete’s foot (tinea pedis) is the most common. The infection mainly affects the skin between the fourth and fifth toe: it sometimes takes on a red color, or the appearance of a white maceration, and the skin peels off easily in dandruff (scales). Fluid-filled blisters can form all around, usually itching. The sole of the foot can also be affected: the skin is red and covered with scales that look like calluses and flake off. This infection is called “moccasin-type” in reference to the form of the rash.
  • The nail fungus (onychomycosis) mainly affects the toenails, rarely the fingernails. The nail has a dark coloration, usually on the edge. A thick layer of fungus often accumulates under the nail. When the nail is fully affected, it peels off. The new nail may also be affected.
  • The groin yeast infection (tinea cruris) mainly affects men. Unilateral rings, red to brown in color, are characteristic of the infection. Sometimes the lesion or the area around it contains small ulcers.
  • The yeast infection of the trunk (tinea corporis) presents as red, scaly, ring-shaped lesions. In popular parlance, we also speak of the “wheel of Saint Catherine”. It heals in the center, where the skin returns to its normal appearance. This skin yeast infection is often transmitted by animals.
  • The scalp yeast infection (tinea capitis) appears as scaly patches, in which the hair is broken or has disappeared. Superinfection sometimes occurs, characterized by the presence of pus on the lesions. Occasionally, abscesses (kerions) can form, which mask the underlying yeast infection.
  • The candidiasis are caused by yeast, another type of fungus. They are more common in people with diabetes, people with weakened immunity, people with dentures and people who have taken long-term antibiotic therapy.
    • They usually appear in areas of the body that are warm and moist, such as the skin folds, the groin area, the armpits, the area under the breasts or in and around the navel, in the intergluteal fold, at the commissure lips and between the toes. The skin becomes red, macerated and generally a little cracked. Small satellite lesions can be seen nearby.
    • An infection can also occur in the vagina and on the penis, causing a white discharge associated with severe itching.
    • Oral candidiasis (Lily of the valley) is common in babies, who develop small white dots on the inside of the cheeks and on the tongue.
    • The nails can also be affected (onychomycosis). In this case, there are transverse lines and irregularities.

How is the diagnosis made?

The diagnosis of skin yeast infection is usually made on the basis of the appearance of the skin lesions. But be careful, a skin yeast infection often looks a lot like another skin condition, such as some forms of eczema. A microscopic examination and a culture of dander taken from the skin or nails are therefore very meaningful. However, you may have to wait up to 6 weeks for the results of a fungus culture. This is why treatment is usually started even before the result is known. If pus forms, a sample is sent to the laboratory for a culture of bacteria. If there is a white discharge from the vagina, a sample can be taken with a specific cotton swab and sent to the laboratory.
If you have regular contact with animals such as cats, dogs, guinea pigs and cattle, report it to the doctor, as this can help him make the correct diagnosis.

What can you do ?

Good hygiene can prevent many infections. Fungi and yeasts multiply very easily in humid environments. It is therefore very important to dry your scalp and skin folds well after showering. If you must wear safety shoes, preferably use cotton or wool socks. And change your socks every day.

What can your doctor do?

There are two types of products for the treatment of yeast infections: on the one hand ointments, creams, lotions and powders for topical use, and on the other hand medicines for oral use.

In the case of a yeast infection of the foot, groin and trunk, local application of a cream is generally sufficient. Most often, a cream containing terbinafine or an azole derivative is used for 1 to 4 weeks (depending on the product and the condition).
For the treatment of scalp, there is a shampoo based on ketoconazole. If the problem is not resolved, treatment with terbinafine tablets will be prescribed for 4 weeks. Another possible solution is itraconazole given for 4-6 weeks.

For’onychomycose, the most effective treatment is terbinafine. The treatment lasts 3 to 4 months for the toenails and 6 weeks for the fingernails. Another possibility for fingernails is intermittent treatment (pulse therapy) with itraconazole 1 week per month for 3 to 4 months. Amorolfine-based varnish can be applied directly to the nail. This varnish can be effective if the onychomycosis is limited to the tip of the nail. The treatment of onychomycosis is often very disappointing. Healing is only achieved about once in two, even after prolonged treatment. Some medicines (such as terbinafine or itraconazole) can be very harmful to the liver. Before starting treatment, the doctor will therefore, in some cases, order a blood test to check your liver function (liver function). You will be carefully monitored throughout the treatment.

For the candidiasis, an azole derivative will be prescribed. They are available in different forms depending on the condition to be treated (skin cream and powder, mouth gel, capsule and cream for vaginal use). Vaginal candidiasis can be treated locally or orally. If the partner has no symptoms, it is not necessary to treat them.

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