Fungal Diseases: Types and Treatment

What is Skin Fungus?

Skin fungus is a general term used for various superficial fungal infections that can develop on the skin, hair, or nails.

However, "fungus" is not a single disease.

The infection:

which fungal group it originates from,

where in the body it is located,

whether it affects hair or nails

It significantly alters the treatment.

Fungi called dermatophytes can infect keratinized tissues in the skin, hair, and nails, causing conditions known as tinea.

Briefly, what you need to know

Not every itchy or scaly rash is a fungal infection.

Fungal infections can be contagious.

Athlete's foot can spread to other areas and nails.

Cortisone cream can alter the appearance of the fungal infection, making diagnosis more difficult.

The treatment for skin fungus and nail fungus is not the same.

Scalp fungus usually cannot be treated with cream alone.

Treatment-resistant dermatophyte infections are becoming increasingly important.

What are the different types of mushrooms?

Different names are used depending on the anatomical region.

Tinea corporis — body fungus

It is a dermatophyte infection that develops on hairless skin areas such as the trunk, arms, or legs.

Classic look:

It is a ring-shaped lesion with more active and scaly edges, expanding outwards, and with a relatively open center.

However, it may not always look as typical as it does in the textbook.

Tinea pedis — athlete's foot

Although it most commonly occurs between the toes, it can also spread to the soles and sides of the feet.

Itching

Flaking

Cracking

Whitening/maceration between the fingers

Combustion

visible.

Some patients may develop a moccasin-like appearance characterized by dry, thick scaling affecting a large portion of the sole of their foot.

Tinea cruris — groin fungus

It is a dermatophyte infection that can spread from the groin creases to the inner thighs.

Especially:

heat and humidity,

sweating,

tight/occlusive clothing,

accompanying athlete's foot

It can facilitate the spread.

Tinea manuum — hand fungus

It can manifest particularly as widespread dryness and flaking on the palms of the hands.

Sometimes it's classic:

“"two feet – one hand"”

It can be found together with athlete's foot due to its pattern.

Therefore, treating only the hand and leaving the infection in the foot untreated can lead to recurrence. The American Academy of Dermatology (AAD) also emphasizes the importance of treating multiple infected areas simultaneously.

Tinea faciei — fungal infection of the face

It is a dermatophyte infection that develops on the face.

It can be confused with eczema, rosacea, or other inflammatory diseases.

The classic ring-shaped appearance may disappear, especially if cortisone was used.

Tinea barbae — beard area fungus

Dermatophyte infections in the beard area can sometimes be quite inflammatory.

Because hair follicles are affected, it may require different treatment than for superficial skin fungus.

Tinea capitis — fungal infection of the scalp

It is especially important for children.

Flaking

Broken hair

Black dots

Hairless areas

It can create.

In some patients, intense inflammation can lead to the development of a swollen, tender, and oozing plaque called a kerion.

There is an important difference in treatment here:

In scalp dermatophyte infections, antifungal shampoos or creams alone are usually insufficient; systemic antifungal treatment is necessary.

Tinea unguium / Onychomycosis — nail fungus

In the nail:

thickening,

color change,

breaking,

debris under the fingernails,

the nail separating from the nail bed

visible.

But the important point is:

Not all thick or yellow nails are fungal.

Psoriasis, trauma, and other nail diseases can create a similar appearance.

Is pityriasis versicolor also a fungal infection?

Yes, it is a superficial fungal disease; however, it differs from classic dermatophyte infections.

The causative agents are yeasts of the Malassezia species.

It can form areas of light or dark, fine, scaly patches, especially on the torso, shoulders, and upper arms.

Even if the microorganism is controlled after treatment, it may take weeks or months for the discoloration to return to normal.

Therefore, the patient:

“"The medication didn't work, the spots are still there."”

he can say.

However, the active infection may have resolved, but the pigmentation may not yet have returned to normal.

How is fungal infection transmitted?

Dermatophytes:

from person to person,

from animal to human,

from contaminated surfaces,

from another infected area on the person's own body

It can spread.

Hot and humid environments, in particular, can facilitate the development of infection.

Shared towels, some personal items, changing rooms, and shared shower areas can all play a role in the transmission of the virus.

However:

“"Your fungal infection definitely came from the pool."”

The source of infection cannot always be definitively identified.

Can fungal infections be transmitted from pets?

Yes.

Some dermatophyte species can be transmitted from animals to humans.

Veterinary evaluation may be necessary, especially if similar lesions appear in more than one person in the household and the pet also has skin/coat problems.

How is a fungal infection diagnosed?

In typical cases, the clinical presentation can strongly suggest the diagnosis.

However, when necessary:

skin scraping,

KOH direct microscopy,

fungal culture,

In some cases, molecular examinations,

examination of the nail sample

available.

Mycological confirmation becomes particularly important in treatment-resistant or atypical infections.

The AAD specifically recommends confirming fungal infection with KOH examination whenever possible in cases suspected of resistant T. indotineae.

Can eczema and fungal infections be confused?

Very often.

Tinea corporis:

nummular eczema,

contact dermatitis,

psoriasis,

pityriasis rosea

It can mimic many diseases, such as those mentioned.

The opposite is also possible: Eczema might be mistaken for a fungal infection, leading to unnecessary use of antifungal medication for weeks.

Therefore, one of the first things to do when diagnosing treatment-resistant "fungus" is:

Is the diagnosis really correct?

It is about asking the question again.

Can cortisone cream cure a fungal infection?

This section is very important.

No.

Because corticosteroids suppress inflammation, they can temporarily reduce redness and itching. Patient:

“"The cream worked very well."”

That's what they might think.

However, the fungus does not disappear.

Moreover, steroids can alter the classic appearance of an infection and contribute to its spread.

This condition is called tinea incognito.

Therefore, combination creams containing cortisone and antifungal agents, especially when used without a diagnosis, can create problems.

How is skin fungus treated?

Treatment varies depending on the location and extent of the infection.

Topical antifungals

In superficial infections such as limited tinea corporis, tinea cruris, or tinea pedis:

terbinafin,

azole group antifungals

Topical medications such as these can be used.

The AAD states that topical antifungal treatment may be sufficient for most limited cutaneous dermatophytosis cases.

Systemic antifungals

Oral antifungal treatment:

common disease,

scalp involvement,

some nail infections,

resistance to topical treatment,

certain deep or inflammatory infections

It may be necessary in situations such as these.

Drug interactions, liver disease, and other individual risks should be evaluated according to the medication being used.

Why do antifungal medications sometimes fail to work?

There could be several reasons for this:

1. The diagnosis is incorrect. It could actually be eczema or psoriasis.

2. Treatment was stopped too early.

3. Other infection foci in the body remain untreated. For example, a groin infection can recur while an athlete's foot persists.

4. Treatment adherence is insufficient.

5. The pathogen may be resistant to the antifungal agent used.

The last point is now more important than it used to be.

What is antifungal resistance?

In recent years, terbinafine-resistant dermatophyte infections have been reported with increasing frequency internationally.

Especially Trichophyton indotineae:

able to spread over large areas,

inflammatory,

recurrent,

resistant to conventional treatments

It is associated with tinea corporis/cruris syndromes.

AAD has therefore created a separate clinical resource for resistant dermatophytes.

This development sets our page apart from typical "apply antifungal cream" content.

But we won't scare the patient either:

Not all fungal strains responding slowly to treatment are resistant to T. indotineae.

First, the diagnosis needs to be confirmed.

Will the fungus recur?

Yes.

Especially:

keeping feet damp for a long time,

accompanying nail fungus,

shared use of items,

premature discontinuation of treatment,

failure to treat other infection foci in the body

It can contribute to recurrence or reinfection.

The AAD also recommends that all infected areas be treated together and that personal belongings not be shared.

What precautions should be taken at home?

The infected area should be kept clean and dry.

Towels and personal items should not be shared.

Sweaty clothes should be changed.

Socks should be changed regularly when treating athlete's foot.

The lesion should not be scratched or rubbed into other areas.

Treatment should not be stopped before the time recommended by the doctor.

If a pet has a suspicious lesion, a veterinary evaluation should be considered.

Frequently Asked Questions

Is skin fungus contagious? Yes, dermatophyte infections can spread from person to person, from animals to humans, or from contaminated surfaces.

Why do fungal infections recur? Inadequate treatment, reinfection, the presence of another infected area, or, more rarely, antifungal resistance may play a role.

Is it okay to add cortisone to antifungal cream? Using steroids without diagnosis and indication can alter and worsen the course of the infection.

Can athlete's foot spread to the nails? Yes. Long-standing tinea pedis can be associated with nail infections.

Can nail fungus be cured with cream? Not always. Nail involvement is evaluated differently than skin fungus, and some patients may require systemic treatment.

Can discoloration remain after antifungal treatment? Yes. Especially after inflammation, or after pityriasis versicolor, discoloration may persist for a while after the infection has cleared.

Can tests be done for fungus? Yes. KOH microscopy, culture, and other mycological methods can be used where appropriate.