With the heat of the summer fast approaching, I thought we should consider some summer related “sweaty” infections… common FUNGAL INFECTIONS!
- Athelete´s Foot (Tinea Pedis)
- Ringworm (Tinea Corporis and Tinea Capitis)
- Tinea Versicolor
- Nail Infections (Onychomycosis)
- Yeast Infections (Candidiasis)
What is a fungus? A fungus is a spore producing organism that feeds on living matter. The group includes moulds, yeasts and mushrooms. It is not a bacteria or a virus.
Causes and Risk Factors: All fungi thrive in warm, moist and sweaty conditions.
Whilst the infections can occur almost anywhere, they are most commonly found in damp areas or where two skin areas touch or rub together eg armpits, groin, skin folds and between the fingers and toes. Favourable conditions allow the fungi to multiply.
In otherwise healthy adults, hot, humid and sweaty weather as well as restrictive clothing may produce these conditions. Poor hygiene undoubtedly contributes. Work or leisure in wet conditions is also a significant factor. Use of communal towels and sheets can transfer spores. Be aware that spores can survive for months or years.
Some diseases increase the risk, including: obesity, diabetes, underactive thyroid and a weakened immune system (for whatever reason).
Certain medications may also increase the risk, including: commonly corticosteroid creams. Birth control pills and antibiotics are other possible causes.
Symptoms: The severity of each symptom changes depending upon the body location however, all fungal infections produce similar symptoms:
- red or purple patches (area with an altered surface)
- white, flaky or scaling, shedding areas
- skin cracks in the skin
- areas of redness
- the appearance of soft white skin
- creamy satellite pustules (pimples filled with pus) at margins of affected areas
- red and white lesions in the mouth, as seen in oral thrush
Athlete’s Foot (Tenia Pedis)
This is a very common fungal infection of the feet. It affects all ages but is more common in adults than in children. It causes peeling, redness, itching, burning, and sometimes cracking, blisters and sores. It has various patterns and may affect one or both feet.
The fungus lives on dead tissue of outer skin layers, nails and hair. There are at least four kinds of fungus that can cause athlete’s foot. The most common of these fungi is trichophyton rubrum.
Ringworm (Tenia Corporis)
Ringworm is not a “worm”! Instead, it is a skin infection caused by a mold like fungi that lives on dead tissues. It can occur anywhere on the body.
The telltale sign is a red, scaly patch or bump that itches. Over time, the bump turns into a ring or circle-shaped patch. It may turn into several rings. The inside of the patch is usually clear or scaly. The outside might be slightly raised and bumpy. Scalp ringworm (Tinea Capitis) tends to start out as a bump or small sore. It may turn flaky and scaly and the scalp may feel tender and sore to the touch. The hair then begins to fall out in patches.
Ringworm is highly contagious. It is passed on in several ways:
- From another person: Ringworm often spreads by skin-to-skin contact. Trichophyton rubrum (T. rubrum) is the most common cause
- From animals: Microsporum canis (M. canis) from cats and dogs. verrucosum, from farm cattle. Washing hands with soap and water is usually sufficient to remove the spores.
- By touching objects: The fungi and spores can linger on surfaces, clothes, towels, in combs and brushes, floors and other surfaces.
- From soil: Infected soil can spread the fungi and spores onto bare skin.
It may be acute (sudden onset and rapid spread) or chronic (slow extension of a mild, barely inflamed, rash). It usually affects exposed areas but may also spread from other infected sites.
Nail Infections (Tinea Unguium or Onychomycosis):
Onychomycosis can be due to:
- Dermatophytessuch as Trichophyton rubrum (T rubrum), T. interdigitale: it often results from untreated tinea pedis (feet) or tinea manuum (hand). It may follow an injury to the nail.
- Yeastssuch as Candida albicans: generally results from paronychia and starts near the nail fold (the cuticle). The nail fold is swollen and red, lifted off the nail plate. White, yellow, green or black marks appear on the nearby nail and spread. The nail may lift off its bed and is tender when pressed.
- Mouldsespecially Scopulariopsis brevicaulis and Fusarium species: are usually indistinguishable from tinea unguium
It may affect one or more toenails and/or fingernails but most often involves the great toenail or the little toenail. It can present in one or several different patterns. The infection develops slowly and causes the nail to become discoloured, thickened and distorted. A fungal nail infection may not cause any obvious symptoms at first.
However, as it progresses, the infection can cause:
- discolouration of the nail– it may turn white, black, yellow or green
- thickening and distortion of the nail– it may become an unusual shape or texture and be difficult to trim
- pain or discomfort– particularly when using or placing pressure on the affected toe or finger
- brittle or crumbly nails – pieces may break off and come away completely
Sometimes the skin nearby may also become infected and be itchy and cracked or red and swollen.
Tinea Versicolor (Pityriasis Versicolor):
Is caused by a type of yeast that naturally lives on the skin, so it is not contagious. When the yeast grows out of control, the skin disease appears as a multicoloured rash or patches anywhere on the body but are most commonly seen on the neck, chest, back, and arms. The condition can affect people of any skin colour. It is more likely to affect teenagers and young adults.
The yeast produces acid which bleaches the skin a different colour than the surrounding skin. The spots or patches may be white, pink, red or brown and can be lighter or darker than the skin around them. The patches do not tan like the rest of the normal skin. The spots may disappear during cool weather and worsen during warm and humid weather. They may be dry and scaly and may itch or hurt, although this is not common.
Candidiasis or Thrush:
Over 90% of vaginal yeast infections are caused by Candida albicans. Other Candida species make up the remainder of infections. “Thrush” in not a “ladies only” condition! It can be transmitted by sex but is not considered a sexually transmitted disease as it can occur in healthy women and those not sexually active.
Candidal vulvovaginitis: This common female condition presents with intense itching, burning, soreness and a thick creamy white discharge. Pain can occur during intercourse or on urination. The area is moist, usually red rash or patch of skin with sloughed skin and possibly swelling.
Candidal balanitis: Signs and symptoms vary but may include tiny blisters, pus filled blisters or persistent ulcerations on the glans penis. The skin can be dry, red, superficially scaly and itchy. Exacerbations following intercourse are common.
Fungal spores are everywhere. Happily, there are several simple steps to prevent infection:
- Keep skin clean and dry
- Wear flip-flops in locker rooms and public showers etc
- Change socks and underwear at least once each day and change out of damp sportswear as soon as possible
- Do not share clothes or towels
- Wash hands with soap and water after playing with pets
- Wear undergarments made of natural materials eg cotton, to allow “breathing”
- Clip nails to keep them short and ensure nail salon equipment is sterile
- Avoid female perfumed douches and sprays
- Baby talc or mycota powder (antifungal talc) helps prevent moisture especially useful in shoes
Natural essential oils and remedies can be beneficial in prevention of the original condition as well as spread of an existing condition (see below).
HOME REMEDIES: There are a number of well known natural antifungal remedies:
Apple Cider Vinegar: Dilute with an equal amount of water, then apply it externally on the affected skin. Leave it on for 30 minutes. The affected area can even be soaked in this solution for 30 minutes. When done, pat dry the area thoroughly. You can use any of these remedies until you get rid of the infection.
Plain Active Yogurt: Soak cotton in plain yogurt and apply it on the infected area. Leave it on for 30 minutes, and then rinse it off with warm water and pat dry. Follow this remedy two times a day until the infection clears.
Garlic: Crush two garlic cloves and add a few drops of olive oil to make a paste. Apply the paste on the affected areas and leave it on for 30 minutes. Then wash the area with lukewarm water and pat dry the skin thoroughly. Follow this treatment twice daily until you get rid of the infection.
Tea Tree Oil: Mix together equal amounts of pure tea tree oil and olive oil or sweet almond oil. Apply this solution on the affected skin area several times a day. Or, three parts of tea tree oil and one part of aloe vera gel. Rub either mixture on the infected area twice daily. Both remedies must be followed for several weeks.
Note: Pregnant women should not use tea tree oil remedies.
Coconut Oil: Gently rub extra-virgin coconut oil on the affected area and allow it to dry on its own. Repeat two or three times daily until the infection clears up. Or, mix equal amounts of coconut oil and cinnamon oil and apply it on the affected area. Follow this remedy twice daily to control the growth of the infection.
Tea: Save used teabags! Apply the cold tea bags to the affected area. Repeat this remedy three times daily until the infection clears up completely. Alternatively, soak affected feet in warm strong tea for 30 minutes. Repeat twice daily for five to six weeks.
Oregano Oil: Mix equal amounts of oregano oil and extra-virgin olive oil. Apply this mixture on the affected area and leave it on for a few hours.
Olive Leaf: Grind a few olive leaves to make a paste. Apply it directly on the affected area. Leave it on for 30 minutes, rinse it off with warm water and pat dry the skin thoroughly. Follow this remedy once or twice daily until the infection is gone.
Turmeric: Apply the juice of raw turmeric root on the affected skin area. Leave it on for two to three hours, and then rinse off with lukewarm water. Follow this remedy twice daily until the infection clears.
OVER THE COUNTER (OTC) THERAPY
These topical antifungals consist of creams, liquids, sprays, shampoos and pessaries used to treat fungal infections of the skin, scalp and nails. Different medications are available OTC in different countries. Active medications include: clotrimazole, econazole, ketoconazole, miconazole, tioconazole, terbinafine, and amorolfine.
Sometimes an antifungal is combined with other medications such as a mild steroid. The antifungal cream clears the infection, and the mild steroid cream reduces the inflammation caused by the infection.
TRADITIONAL MEDICINE TREATMENTS:
All fungal infections are treated in a similar manner but the exact medication delivery depends upon the location and severity of symptoms. It consists of creams, lotions, shampoos, nail paints and talc powders. However, it can also include medication given as pills. Numerous local fungal treatments are available over the counter at the pharmacy. Oral medications usually require a prescription. All medications are usually taken for a few weeks/ months or in pulses. This is needed to kill the “new” fungi which grow from spores which cannot be killed by the medication.
By Dr. Johanna Clark – Club de Mar Medical Centre