Many skin mycoses (fungal skin infections) are caused by fungus prevalent in the natural skin microbiome. Some of these fungi can induce infection through wounds, whereas others primarily cause opportunistic infections in immunocompromised children. Other fungal pathogens infect children in exceptionally wet situations that encourage fungal proliferation; for example, sweaty footwear, communal showers, and locker rooms are great breeding grounds for fungal pathogens to develop and spread. Fungal infections, also known as mycoses, are classified according to their invasiveness. Cutaneous mycoses are mycoses that induce superficial infections of the epidermis, hair, and nails. Subcutaneous mycoses are mycoses that infect deeper tissues by penetrating the epidermis and dermis. Systemic mycoses are infections that spread throughout the body.
What is Skin Mycosis?
Skin mycosis, or skin fungal infection, is divided into four categories based on their degree of invasiveness: superficial, cutaneous, subcutaneous, and systemic.
Fungi that damage the superficial layers of skin, hair, and nails cause superficial and cutaneous mycoses. The key distinction is that superficial mycoses generate little or no inflammation, whereas cutaneous mycoses usually cause skin redness and irritation as a result of an inflammatory reaction.
Subcutaneous mycoses are localized infections of the skin and underlying tissue that usually develop as a result of skin cut or puncture wounds (e.g., from a rose thorn). Fungi from the environment can enter the skin and get access to deeper tissues through the break in the skin.
Finally, opportunistic fungi induce systemic mycoses, which damage internal organs (e.g., the lungs, brain, and gastrointestinal tract). These microorganisms are usually harmless to healthy children, but they can cause disease if they find an opportunity, such as a compromised immune system.
Is Skin Mycosis Serious?
Although fungal skin infections and fungal nail infections are unpleasant and irritating, they are rarely dangerous. Athlete's foot, ringworm, and jock itch are all fungal diseases that are simple to catch and spread. The fungus does not normally spread beyond the skin's surface in healthy children, making them simple to treat. If you spend a lot of time at the gym or in a public swimming pool, you are prone to get it.
Skin Mycosis Types
Dermatophytes, fungal molds that need keratin, a protein found in skin, hair, and nails for growth, cause tineas, a category of cutaneous mycoses. Trichophyton, Epidermophyton, and Microsporum are three families of dermatophytes that can cause cutaneous mycoses. Tineas on most parts of the body are commonly referred to as ringworm, however, tineas in specific places may have different names and symptoms. Keep in mind that, despite their Latinization, these names refer to body parts, not causative organisms. Tineas can be caused by a variety of dermatophytes and can affect any part of the body.
Dermatophytes are prevalent in the environment and soils, and they are easily transferred to the skin through contact with other children and animals. Hair can also disseminate fungal spores. In wet, gloomy conditions, many dermatophytes grow. Tinea pedis (athlete's foot), for example, is frequently disseminated in public showers, and the causative fungi survive in the dark, wet confines of sweaty shoes and socks. Tinea cruris (jock itch) grows in warm, moist undergarments and typically spreads in communal living conditions.
Tineas on the body (tinea corporis) frequently cause radial lesions that heal towards the center. This results in the creation of a red ring, giving rise to the misnomer of ringworm.
Aspergillus, a genus of molds that includes many distinct species, including some that cause aspergillosis, is another source of cutaneous mycoses. Primary cutaneous aspergillosis, in which the infection starts on the surface of the skin, is uncommon, although it does happen. Secondary cutaneous aspergillosis is more common, in which the infection starts in the respiratory system and spreads throughout the body. Both primary and secondary cutaneous aspergillosis produce distinct eschars at the infection site or locations.
Aspergillus fumigatus and Aspergillus flavus are the most common causes of primary cutaneous aspergillosis, which occurs at the site of the wound. Children who have been injured while playing in an outdoor environment are more likely to have this condition. Opportunistic infections, on the other hand, can occur in healthcare environments, most commonly at the site of intravenous catheters, venipuncture sites, burns, surgical wounds, or occlusive dressings. Aspergillosis is the second most frequent fungal infection acquired in hospitals, behind candidiasis. It is more frequent in immunocompromised children, who are more susceptible to opportunistic infections.
Skin and Nails Candidiasis
Candida albicans and other Candida yeasts Candida can produce cutaneous candidiasis, which is an infection of the skin. Candida species can cause intertrigo, which is a broad term for a rash that appears in skin folds or other localized skin rashes. Candida can also affect the nails, turning them yellow and hardening them.
Subcutaneous mycoses can extend from the skin to deeper tissues, whereas cutaneous mycoses are superficial. The most prevalent subcutaneous mycosis in temperate areas is sporotrichosis, which is produced by the fungus Sporothrix schenckii and is also termed rose gardener's disease or rose thorn disease. Sporotrichosis is commonly acquired after working with soil, plants, or wood, as the fungus can enter through a minor wound such as a thorn prick or splinter. Sporotrichosis can be avoided in most cases by using gloves and protective clothes while gardening and cleaning and disinfecting any wounds received while participating in outdoor activities as soon as possible.
Sporothrix infections start as little skin ulcers, but the fungus can quickly spread to the lymphatic system and beyond. Nodules form when the infection spreads, becoming necrotic and ulcerating. Abscesses and ulcers may develop across a broader area when more lymph nodes are damaged (often on one arm or hand). The infection may spread more extensively throughout the body in severe cases, but this is rather unusual.
Skin Mycosis Causes
Infections of the skin, hair, and nails can be caused by a variety of fungi and yeasts. These can be dispersed as follows:
- from one person to another
- from animals to humans
- more infrequently, to a person descended from the soil
Some fungal skin infections, such as candida (thrush), are caused by an excess of formerly harmless fungus on the skin.
If you come into contact with an infected child or animal, you can pick up fungus that can cause infection. children who participate in close-contact activities like wrestling are more prone to get fungal skin infections as a result of this. Fungi can also be spread by sharing contaminated clothing, towels, hairbrushes, or bedclothes. If children walk barefoot in common baths and pool areas, you risk picking up fungi on their feet.
Fungi live in warm, wet environments, thus you're more likely to contract an infection if you:
- Are in a hot, humid atmosphere, wear tight apparel or shoes that don't allow the feet to breathe.
- are overweight, and as a result, their skin folds rub against each other.
If you do any of the following, you're more prone to have a fungal skin infection:
- have a reduced immune system as a result of a disease such as HIV or the use of corticosteroids
- suffer from diabetes
- Antibiotics have been taken
- are pregnant
Skin Mycosis Symptoms
A fungal skin infection's symptoms vary depending on the type of fungus or yeast that caused it and where it occurred. Changes in your skin, hair, or nails may occur, which may or may not be bothersome. The fungus might infect one or multiple parts of the body.
A variety of skin rashes can be caused by fungal skin diseases. It's possible that your skin:
- Be scaly, itchy, and red
- Form a fine scale that looks like dry skin
- Becoming red and painful, and pus-filled patches
Psoriasis and eczema are two skin disorders that might be confused with fungus rashes. Fungal skin infections, unlike these disorders, are generally more inflamed around the border than in the center of the patch.
The majority of fungal nail infections are asymptomatic. However, they may induce pain or pins and needles with time, which can make standing, walking, or exercising difficult.
Hair can become brittle and break off due to skin mycosis of the scalp, creating bald patches, but it normally comes back after treatment.
What is Pityriasis Versicolor?
Pityriasis versicolor is a frequently diagnosed skin mycosis that causes flaky, discolored areas on the chest and back.
Pityriasis is a name used to describe skin diseases in which the scale resembles bran. The second component of the term, versicolor, comes from the varied colors of pityriasis versicolor. Tinea versicolor is another name for Pityriasis versicolor, although the term tinea should only be used for dermatophyte mycoses.
Who Gets Pityriasis Versicolor?
Young children are most commonly affected by Pityriasis versicolor, which is somewhat more prevalent in boys than girls. It can impact children, adolescents, and adults of all ages.
In hot, humid regions, Pityriasis versicolor is more frequent than in cool, dry settings. children who sweat a lot are more likely to be affected. It may disappear during the winter months before reappearing in the summer.
Pityriasis versicolor can affect more than one family member, despite the fact that it is not infectious in the traditional way.
Pityriasis Versicolor Causes
Pityriasis versicolor is mediated by the mycelial proliferation of Malassezia fungus.
Malassezia is a natural element of the skin microbiome (microorganisms found on normal skin). They are lipid-dependent for survival. Malassezia has been recognized as 14 distinct species. M. globosa, M. restricta, and M. sympodialis are the most prevalent species grown from Pityriasis versicolor.
Malassezia usually grows sparsely in seborrheic areas such as the scalp, face, and chest and does not cause a rash. It's unclear why they become more prominent on the skin surface and cause pityriasis versicolor. A tryptophan-dependent metabolism is one possibility.
In the brown type of pityriasis versicolor, the yeasts cause larger melanosomes (pigment granules) within basal melanocytes. The yeasts are easier to see in scrapings from this type of pityriasis versicolor than in scrapings from the white type.
The white or hypopigmented form of pityriasis versicolor is hypothesized to be caused by a malassezia-produced substance that disperses into the epidermis and inhibits melanocyte function.
Due to dermatitis generated by malassezia or its byproducts, the pink variety of pityriasis versicolor is mildly irritated.
Skin Mycosis Diagnosis
Tineas can be diagnosed using a variety of methods. A 365 nm wavelength Wood's lamp (also known as a black lamp) is commonly used. The ultraviolet light emitted by Wood's lamp causes the fungal elements (spores and hyphae) to glow when directed on tinea. Fungi can also be detected using direct microscopic examination of skin scrapings, hair, or nails. These specimens are usually prepared in a wet mount using a potassium hydroxide solution (10-20% liquid KOH), which breaks the keratin in hair, nails, and skin cells, allowing the hyphae and fungal spores to be seen. The specimens can be cultured on Sabouraud dextrose Chloramphenicol/cycloheximide, a dermatophyte-specific agar that promotes dermatophyte growth while suppressing bacteria and saprophytic fungi development. Macroscopic colony morphology is frequently employed to determine the dermatophytes' genus; identification can then be established using either a slide culture or a sticky tape preparation stained with lactophenol cotton blue to visualize the microscopic morphology.
child history, cultures, and histopathology using a skin biopsy are used to diagnose cutaneous aspergillosis.
Clinical examination, culture, Gram stain, and KOH wet mounts are used to confirm candidiasis of the skin and nails. An antifungal susceptibility test can also be done.
Sporothrix infection is diagnosed by examining the affected tissue histologically. The mold's macroscopic morphology can be seen by growing it on potato dextrose agar, and the mold's microscopic morphology can be seen by staining a slide culture with lactophenol cotton blue.
The coppery-orange fluorescence of pityriasis versicolor can be demonstrated using a UV blacklight (Wood lamp). Microscopic analysis of scales drenched in potassium hydroxide confirms the diagnosis, revealing the typical grape-like clusters of yeast cells and elongated hyphae.
Skin Mycosis Treatment
If you have a fungal infection, you may not need to see your doctor. You might be able to get rid of fungal infections at home with over-the-counter medications. Your pharmacist will be able to provide you with some guidance. However, if your condition worsens or over-the-counter medications don't help, see your doctor.
There are various things you can take to help prevent a fungal infection from spreading to your skin and other body parts.
- Every day, wash the affected regions.
- After washing or bathing, make sure the skin is completely dry, particularly in the folds.
- Wear cotton or a material that is meant to absorb sweat away from your skin in loose-fitting clothing.
- Keep your feet dry and your nails trimmed if you have a toenail infection.
- Wear cotton socks and breathable, well-fitting shoes.
- Frequently wash your clothes, blankets, and towels.
To avoid infecting others, take the following precautions:
- Personal objects such as towels, clothing, brushes, and combs should not be shared.
- If you have an athlete's foot or a toenail infection, avoid going barefoot in public locker rooms, pools, or gyms.
You can still go to work and your child can still go to school if you have a fungal infection. However, you should begin treatment as soon as possible and remember to maintain excellent hygiene to prevent the infection from spreading.
You don't have to treat an affected toenail that isn't producing any symptoms unless its appearance is upsetting you.
Skin Mycosis Medications
The majority of medications for fungal skin infections are applied topically (you put them directly onto your skin). Creams, lotions, shampoos, and pessaries are among the several fungal infection therapies available. Some of these can be obtained from a pharmacist over the counter, so you won't need to see your doctor.
Your pharmacist will be able to counsel you on the best choice for you. Always read the medication's instruction sheet to learn how to use it and for how long. If you have any concerns, consult the pharmacist.
You may need to take tablets if you have a rash that covers a big region of the skin or affects the nails or scalp. If you've tried a topical treatment and it hasn't helped, your doctor may recommend tablets. Antifungal medications might cause nausea, diarrhea, and headaches as side effects.
It's critical that you follow the directions on your medication or those given to you by your doctor. Depending on the type of skin mycoses you have and how bad it is, you may need to continue therapy for up to two weeks after your symptoms have gone away.
Some fungal infections require significantly longer treatment. If you have a fungal nail infection, for example, you may need to manage it with a topical treatment for up to a year or with tablets for many months. Your nail may take another six months to a year to recover, and it may never appear totally normal.
Fungal infections, especially infections of the feet and toenails, can resurface even after they appear to have cleared up.
Pityriasis Versicolor Treatment
Pityriasis versicolor can be treated by a general practitioner.
The main treatments are antifungal shampoo (like ketoconazole) that you apply to the affected area and then antifungal cream is applied after a few minutes.
A doctor may recommend antifungal medications if pityriasis versicolor affects a big area or if shampoos and creams are ineffective.
After therapy, the skin may take a few months to regain its normal color, and the spots may reappear.
If they return, you may need the same therapy or your doctor may recommend a long-term treatment plan, such as antifungal shampoo every few weeks.
Skin Mycosis Prevention
By adopting a few easy precautions, you can lower your chances of contracting a fungal skin infection.
- After you've washed your skin, make sure it's completely dry, especially in the folds.
- To keep fungi away, wash your socks, garments, and bed linens on a daily basis.
- In community areas such as showers, saunas, and swimming pools, do not walk barefoot.
- Wear loose-fitting cotton or breathable clothes that draw sweat away from your skin.
- Towels, hairbrushes, and combs should not be shared.
- To allow the shoes to dry out, switch them out every two or three days.
- Keep the blood glucose levels under control if you have diabetes mellitus.
- Wash bedding, caps, combs, and hair accessories in bleach diluted with water if somebody in your family has scalp ringworm.
Cutaneous mycoses are a collection of fungal infections that affect the skin, hair, and nails on a superficial level. Different types of fungi, including dermatophytes, Candida yeasts, and other non-dermatophytic fungi, can cause them. The signs and symptoms of a fungal infection vary depending on the type of infection. Dermatophyte infections (tineas), for example, cause itchy, ring-like lesions at the infection site, whereas cutaneous candidiasis causes a localized rash in skinfold areas. Clinical inspection of the lesions often leads to a suspicion of cutaneous mycoses, which can be proven with additional tests such as direct microscopy, fungal cultures, and Wood's lamp examination. By practicing proper hygiene, wearing clothing that facilitates air circulation adjacent to the skin, and keeping the skin clean and dry, an individual can lower their vulnerability to mycoses. Antifungal drugs, either topical or oral, are usually used to treat the condition.