Differentiation of Fungal Skin Infections and Skin Disorders

Differentiation of Fungal Skin Infections and Skin Disorders

• Fungal skin infections occur on areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms.

• Contact dermatitis can occur on any area of the body exposed to the allergen/irritant, with hands, face, legs, ears, eyes, and anogenital area involved most often.

• Bacterial skin infections can occur anywhere on the body.

• Fungal skin infections present as soggy, malodorous, thickened skin, or as acute vesicular rash, or fine scaling of affected area with varying degrees of inflammation.

• Contact dermatitis presents as a variety of lesions, including raised wheals, fluid-filled vesicles, or both.

• Bacterial skin infections present as a variety of lesions, including macules, pustules, and ulcers with redness surrounding the lesion.

• Fungal skin infections cause itching and pain.

• Contact dermatitis causes itching and pain.

• Bacterial skin infections cause irritation and pain.

Tinea Pedis

• Tinea pedis has four accepted variants, which may overlap.
• This type of infection can be complicated by an overgrowth of opportunistic, gram-negative bacteria, producing an extremely painful, erosive, purulent interspace.
• Tinea pedis is most commonly seen in the interdigital space between the fourth and fifth digits.

Tinea Unguium

• Nails affected by tinea unguium gradually lose their normal shiny luster and become opaque.
• If left untreated, the nails become thick, rough, yellow, opaque, and friable.
• The nail may separate from the nail bed if the infection progresses secondarily to subungual hyperkeratosis.
• Ultimately, the nail may be lost altogether.

Tinea Corporis

• Tinea corporis may have a diverse clinical presentation.
• Lesions, which involve glabrous skin, begin as small, circular, erythematous, scaly areas.
• The lesions spread peripherally, and the borders may contain vesicles or pustules.
• Infected individuals may also complain of pruritus.
• Tinea corporis can occur on any part of the body.
• The location of the infection can provide clues to the type of infecting dermatophyte.

Complementary Therapies

• Oil of Bitter Orange, Tea Tree Oil, and Garlic have been used with some success in the management of fungal skin infections, with few or no side effects.

Non-Drug Measures

• Use a separate towel to dry the affected area or dry the affected area last to prevent spreading the infection to other parts of the body.
• Do not share towels, clothing, or other personal articles with household members, especially when an infection is present.
• Launder contaminated towels and clothing in hot water, and dry them on a hot dryer setting to prevent spreading the infection.
• Cleanse skin daily with soap and water, and thoroughly pat dry to remove oils and other substances that promote growth of fungi.
• If possible, do not wear clothing or shoes that cause the skin to stay wet.
• Allow shoes to dry thoroughly before wearing them again, and dust shoes with medicated or non-medicated foot powder to help keep them dry.
• If needed, place odor-controlling insoles in casual or athletic shoes, and change them routinely every 3-4 months or more often if their condition warrants.
• Discontinue the use of an antifungal if irritation, sensitization, or worsening of the skin condition occurs.
• Avoid contact with people who have fungal infections, and wear protective footwear in areas of family or public use.

Key Points for Fungal Skin Infections

• Tinea corporis, tinea cruris, and tinea pedis can be treated with nonprescription drugs.

Tinea Capitis

• In addition to fever and pain, individuals with tinea capitis may experience a higher degree of pruritus.
• Regional lymph nodes may also be enlarged.
• The black dot variety of tinea capitis is named for the appearance of infected areas of the scalp, where arthrospores on the hair shaft cause hairs to break off at the level of the scalp, leaving black dots on the scalp surface.
• Hair loss, inflammation, and scaling with this type of tinea capitis range from minimal to extensive.
• The favus variant of tinea capitis typically presents as patchy areas of hair loss and scutula (yellowish crusts and scales).
• If left untreated, this condition can lead to secondary bacterial infections, scalp atrophy, scarring, and permanent hair loss.

Pityriasis Versicolor (Tinea Versicolor)

• Pityriasis versicolor is characterized by hyper- and hypopigmented scaly patches.
• On dark skin, the lesions often appear as hypopigmented areas, while on light skin they are slightly erythematous or hyperpigmented.
• The expression of infection is promoted by heat and humidity.
• The typical lesions consist of oval scaly macules, papules, and patches concentrated on the chest, shoulders, and back, but only rarely on the face or distal extremities.
• It is caused by yeasts of the Malassezia genus.
• Topical treatment usually is adequate unless there is extensive involvement, recurrent infections, or failure of topical therapy.

Tinea Cruris

• Tinea cruris is more common in males and occurs on the medial and upper parts of the thighs and the pubic area.
• The lesions have well-demarcated margins that are elevated slightly and are more erythematous than the central area.
• Small vesicles may be seen, especially at the margins.
• Acute lesions are bright red, and chronic cases tend to have more of a hyperpigmented appearance.
• Fine scaling is usually present.
• This condition is generally bilateral with significant pruritus.
• The lesions usually spare the penis and scrotum.
• Pain may also be present during periods of sweating or when the skin becomes macerated or infected by a secondary microorganism.

Tinea Cruris Case Study

• A 54-year-old man with tinea cruris and corporis for decades despite multiple treatments with oral antifungal medications.
• His cultures show T. rubrum sensitive to all the typical oral antifungal medications, but his tinea never completely clears.
• He does not have a known immunodeficiency, but his immune system appears not to recognize the T. rubrum as foreign.

Tinea Capitis Variants

• Clinically, tinea capitis may present as one of four variant patterns, depending on the causative dermatophyte.
• In non-inflammatory tinea capitis, lesions begin as small papules surrounding individual hair shafts.
• Subsequently, the lesions spread centrifugally to involve all hairs in their path.
• Although there is some scaling of the scalp, little inflammation is present.
• Hairs in the lesions are a dull gray color and usually break off above the scalp level.
• The inflammatory type of tinea capitis produces a spectrum of inflammation, ranging from pustules to kerion formation.

Differentiation of Fungal Skin Infections and Skin Disorders with Similar Presentation

• Criterion: Location
  • Fungal skin infections: On areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms.
  • Contact dermatitis: Any area of the body exposed to the allergen/irritant; hands, face, legs, ears, eyes, and anogenital area involved most often.
  • Bacterial skin infections: Anywhere on the body.
• Criterion: Signs
  • Fungal skin infections: Presents either as soggy, malodorous, thickened skin; acute vesicular rash; or fine scaling of affected area with varying degrees of inflammation.
  • Contact dermatitis: Presents as a variety of lesions: raised wheals, fluid-filled vesicles, or both.
  • Bacterial skin infections: Presents as a variety of lesions from macules to pustules to ulcers with redness surrounding the lesion.
• Criterion: Symptoms
  • Fungal skin infections: Itching and pain.
  • Contact dermatitis: Itching and pain.
  • Bacterial skin infections: Irritation and pain.
• Criterion: Quantity/Severity
  • Fungal skin infections: Usually localized to one region of the body but can spread.
  • Contact dermatitis: Affects all areas of exposed skin but does not spread.
  • Bacterial skin infections: Usually localized to one region of the body but can spread.
• Criterion: Timing
  • Fungal skin infections: Variable onset.
  • Contact dermatitis: Variable onset from immediately after exposure to 3 weeks after contact.
  • Bacterial skin infections: Variable onset.
• Criterion: Cause
  • Fungal skin infections: Superficial fungal infection.
  • Contact dermatitis: Exposure to skin irritants or allergens.
  • Bacterial skin infections: Superficial bacterial infection.
• Criterion: Modifying Factors
  • Fungal skin infections: Treated with nonprescription astringents, antifungals, and nondrug measures to keep the area clean and dry.
  • Contact dermatitis: Treated with topical antipruritics, skin protectants, astringents, and nondrug measures to avoid reexposure.
  • Bacterial skin infections: Treated with prescription antibiotics.

Tinea Pedis

• Clinically, tinea pedis has four accepted variants; two or more of these types may overlap.

Tinea Capitis

• In addition to fever and pain, individuals with tinea capitis may experience a higher degree of pruritus.
• Regional lymph nodes may also be enlarged.
• The black dot variety of tinea capitis is named for the appearance of infected areas of the scalp, where arthrospores on the hair shaft cause hairs to break off at the level of the scalp, leaving black dots on the scalp surface.
• Hair loss, inflammation, and scaling with this type of tinea capitis range from minimal to extensive.
• The favus variant of tinea capitis typically presents as patchy areas of hair loss and scutula (yellowish crusts and scales).
• If left untreated, this condition can lead to secondary bacterial infections, scalp atrophy, scarring, and permanent hair loss.

Pityriasis Versicolor (Tinea Versicolor)

• Pityriasis versicolor is characterized by hyper- and hypopigmented scaly patches.
• On dark skin, the lesions often appear as hypopigmented areas, while on light skin they are slightly erythematous or hyperpigmented.
• The expression of infection is promoted by heat and humidity.
• The typical lesions consist of oval scaly macules, papules, and patches concentrated on the chest, shoulders, and back, but only rarely on the face or distal extremities.
• It is caused by yeasts of the Malassezia genus.
• Topical treatment usually is adequate unless there is extensive involvement, recurrent infections, or failure of topical therapy.

Tinea Cruris

• Tinea cruris is more common in males and occurs on the medial and upper parts of the thighs and the pubic area.
• The lesions have well-demarcated margins that are elevated slightly and are more erythematous than the central area.
• Small vesicles may be seen, especially at the margins.
• Acute lesions are bright red, and chronic cases tend to have more of a hyperpigmented appearance.
• Fine scaling is usually present.
• This condition is generally bilateral with significant pruritus.
• The lesions usually spare the penis and scrotum.
• Pain may also be present during periods of sweating or when the skin becomes macerated or infected by a secondary microorganism.

Tinea Cruris Case Study

• A 54-year-old man with tinea cruris and corporis for decades despite multiple treatments with oral antifungal medications.
• His cultures show T. rubrum sensitive to all the typical oral antifungal medications, but his tinea never completely clears.
• He does not have a known immunodeficiency, but his immune system appears not to recognize the T. rubrum as foreign.

Tinea Capitis Variants

• Clinically, tinea capitis may present as one of four variant patterns, depending on the causative dermatophyte.
• In non-inflammatory tinea capitis, lesions begin as small papules surrounding individual hair shafts.
• Subsequently, the lesions spread centrifugally to involve all hairs in their path.
• Although there is some scaling of the scalp, little inflammation is present.
• Hairs in the lesions are a dull gray color and usually break off above the scalp level.
• The inflammatory type of tinea capitis produces a spectrum of inflammation, ranging from pustules to kerion formation.

Differentiation of Fungal Skin Infections and Skin Disorders with Similar Presentation

• Criterion: Location
  • Fungal skin infections: On areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms.
  • Contact dermatitis: Any area of the body exposed to the allergen/irritant; hands, face, legs, ears, eyes, and anogenital area involved most often.
  • Bacterial skin infections: Anywhere on the body.
• Criterion: Signs
  • Fungal skin infections: Presents either as soggy, malodorous, thickened skin; acute vesicular rash; or fine scaling of affected area with varying degrees of inflammation.
  • Contact dermatitis: Presents as a variety of lesions: raised wheals, fluid-filled vesicles, or both.
  • Bacterial skin infections: Presents as a variety of lesions from macules to pustules to ulcers with redness surrounding the lesion.
• Criterion: Symptoms
  • Fungal skin infections: Itching and pain.
  • Contact dermatitis: Itching and pain.
  • Bacterial skin infections: Irritation and pain.
• Criterion: Quantity/Severity
  • Fungal skin infections: Usually localized to one region of the body but can spread.
  • Contact dermatitis: Affects all areas of exposed skin but does not spread.
  • Bacterial skin infections: Usually localized to one region of the body but can spread.
• Criterion: Timing
  • Fungal skin infections: Variable onset.
  • Contact dermatitis: Variable onset from immediately after exposure to 3 weeks after contact.
  • Bacterial skin infections: Variable onset.
• Criterion: Cause
  • Fungal skin infections: Superficial fungal infection.
  • Contact dermatitis: Exposure to skin irritants or allergens.
  • Bacterial skin infections: Superficial bacterial infection.
• Criterion: Modifying Factors
  • Fungal skin infections: Treated with nonprescription astringents, antifungals, and nondrug measures to keep the area clean and dry.
  • Contact dermatitis: Treated with topical antipruritics, skin protectants, astringents, and nondrug measures to avoid reexposure.
  • Bacterial skin infections: Treated with prescription antibiotics.

Tinea Pedis

• Clinically, tinea pedis has four accepted variants; two or more of these types may overlap.

Tinea Capitis

• In addition to fever and pain, individuals with tinea capitis may experience a higher degree of pruritus.
• Regional lymph nodes may also be enlarged.
• The black dot variety of tinea capitis is named for the appearance of infected areas of the scalp, where arthrospores on the hair shaft cause hairs to break off at the level of the scalp, leaving black dots on the scalp surface.
• Hair loss, inflammation, and scaling with this type of tinea capitis range from minimal to extensive.
• The favus variant of tinea capitis typically presents as patchy areas of hair loss and scutula (yellowish crusts and scales).
• If left untreated, this condition can lead to secondary bacterial infections, scalp atrophy, scarring, and permanent hair loss.

Pityriasis Versicolor (Tinea Versicolor)

• Pityriasis versicolor is characterized by hyper- and hypopigmented scaly patches.
• On dark skin, the lesions often appear as hypopigmented areas, while on light skin they are slightly erythematous or hyperpigmented.
• The expression of infection is promoted by heat and humidity.
• The typical lesions consist of oval scaly macules, papules, and patches concentrated on the chest, shoulders, and back, but only rarely on the face or distal extremities.
• It is caused by yeasts of the Malassezia genus.
• Topical treatment usually is adequate unless there is extensive involvement, recurrent infections, or failure of topical therapy.

Tinea Cruris

• Tinea cruris is more common in males and occurs on the medial and upper parts of the thighs and the pubic area.
• The lesions have well-demarcated margins that are elevated slightly and are more erythematous than the central area.
• Small vesicles may be seen, especially at the margins.
• Acute lesions are bright red, and chronic cases tend to have more of a hyperpigmented appearance.
• Fine scaling is usually present.
• This condition is generally bilateral with significant pruritus.
• The lesions usually spare the penis and scrotum.
• Pain may also be present during periods of sweating or when the skin becomes macerated or infected by a secondary microorganism.

Tinea Cruris Case Study

• A 54-year-old man with tinea cruris and corporis for decades despite multiple treatments with oral antifungal medications.
• His cultures show T. rubrum sensitive to all the typical oral antifungal medications, but his tinea never completely clears.
• He does not have a known immunodeficiency, but his immune system appears not to recognize the T. rubrum as foreign.

Tinea Capitis Variants

• Clinically, tinea capitis may present as one of four variant patterns, depending on the causative dermatophyte.
• In non-inflammatory tinea capitis, lesions begin as small papules surrounding individual hair shafts.
• Subsequently, the lesions spread centrifugally to involve all hairs in their path.
• Although there is some scaling of the scalp, little inflammation is present.
• Hairs in the lesions are a dull gray color and usually break off above the scalp level.
• The inflammatory type of tinea capitis produces a spectrum of inflammation, ranging from pustules to kerion formation.

Differentiation of Fungal Skin Infections and Skin Disorders with Similar Presentation

• Criterion: Location
  • Fungal skin infections: On areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms.
  • Contact dermatitis: Any area of the body exposed to the allergen/irritant; hands, face, legs, ears, eyes, and anogenital area involved most often.
  • Bacterial skin infections: Anywhere on the body.
• Criterion: Signs
  • Fungal skin infections: Presents either as soggy, malodorous, thickened skin; acute vesicular rash; or fine scaling of affected area with varying degrees of inflammation.
  • Contact dermatitis: Presents as a variety of lesions: raised wheals, fluid-filled vesicles, or both.
  • Bacterial skin infections: Presents as a variety of lesions from macules to pustules to ulcers with redness surrounding the lesion.
• Criterion: Symptoms
  • Fungal skin infections: Itching and pain.
  • Contact dermatitis: Itching and pain.
  • Bacterial skin infections: Irritation and pain.
• Criterion: Quantity/Severity
  • Fungal skin infections: Usually localized to one region of the body but can spread.
  • Contact dermatitis: Affects all areas of exposed skin but does not spread.
  • Bacterial skin infections: Usually localized to one region of the body but can spread.
• Criterion: Timing
  • Fungal skin infections: Variable onset.
  • Contact dermatitis: Variable onset from immediately after exposure to 3 weeks after contact.
  • Bacterial skin infections: Variable onset.
• Criterion: Cause
  • Fungal skin infections: Superficial fungal infection.
  • Contact dermatitis: Exposure to skin irritants or allergens.
  • Bacterial skin infections: Superficial bacterial infection.
• Criterion: Modifying Factors
  • Fungal skin infections: Treated with nonprescription astringents, antifungals, and nondrug measures to keep the area clean and dry.
  • Contact dermatitis: Treated with topical antipruritics, skin protectants, astringents, and nondrug measures to avoid reexposure.
  • Bacterial skin infections: Treated with prescription antibiotics.

Tinea Pedis

• Clinically, tinea pedis has four accepted variants; two or more of these types may overlap.

Tinea Capitis

• In addition to fever and pain, individuals with tinea capitis may experience a higher degree of pruritus.
• Regional lymph nodes may also be enlarged.
• The black dot variety of tinea capitis is named for the appearance of infected areas of the scalp, where arthrospores on the hair shaft cause hairs to break off at the level of the scalp, leaving black dots on the scalp surface.
• Hair loss, inflammation, and scaling with this type of tinea capitis range from minimal to extensive.
• The favus variant of tinea capitis typically presents as patchy areas of hair loss and scutula (yellowish crusts and scales).
• If left untreated, this condition can lead to secondary bacterial infections, scalp atrophy, scarring, and permanent hair loss.

Pityriasis Versicolor (Tinea Versicolor)

• Pityriasis versicolor is characterized by hyper- and hypopigmented scaly patches.
• On dark skin, the lesions often appear as hypopigmented areas, while on light skin they are slightly erythematous or hyperpigmented.
• The expression of infection is promoted by heat and humidity.
• The typical lesions consist of oval scaly macules, papules, and patches concentrated on the chest, shoulders, and back, but only rarely on the face or distal extremities.
• It is caused by yeasts of the Malassezia genus.
• Topical treatment usually is adequate unless there is extensive involvement, recurrent infections, or failure of topical therapy.

Tinea Cruris

• Tinea cruris is more common in males and occurs on the medial and upper parts of the thighs and the pubic area.
• The lesions have well-demarcated margins that are elevated slightly and are more erythematous than the central area.
• Small vesicles may be seen, especially at the margins.
• Acute lesions are bright red, and chronic cases tend to have more of a hyperpigmented appearance.
• Fine scaling is usually present.
• This condition is generally bilateral with significant pruritus.
• The lesions usually spare the penis and scrotum.
• Pain may also be present during periods of sweating or when the skin becomes macerated or infected by a secondary microorganism.

Tinea Cruris Case Study

• A 54-year-old man with tinea cruris and corporis for decades despite multiple treatments with oral antifungal medications.
• His cultures show T. rubrum sensitive to all the typical oral antifungal medications, but his tinea never completely clears.
• He does not have a known immunodeficiency, but his immune system appears not to recognize the T. rubrum as foreign.

Tinea Capitis Variants

• Clinically, tinea capitis may present as one of four variant patterns, depending on the causative dermatophyte.
• In non-inflammatory tinea capitis, lesions begin as small papules surrounding individual hair shafts.
• Subsequently, the lesions spread centrifugally to involve all hairs in their path.
• Although there is some scaling of the scalp, little inflammation is present.
• Hairs in the lesions are a dull gray color and usually break off above the scalp level.
• The inflammatory type of tinea capitis produces a spectrum of inflammation, ranging from pustules to kerion formation.

Differentiation of Fungal Skin Infections and Skin Disorders with Similar Presentation

• Criterion: Location
  • Fungal skin infections: On areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms.
  • Contact dermatitis: Any area of the body exposed to the allergen/irritant; hands, face, legs, ears, eyes, and anogenital area involved most often.
  • Bacterial skin infections: Anywhere on the body.
• Criterion: Signs
  • Fungal skin infections: Presents either as soggy, malodorous, thickened skin; acute vesicular rash; or fine scaling of affected area with varying degrees of inflammation.
  • Contact dermatitis: Presents as a variety of lesions: raised wheals, fluid-filled vesicles, or both.
  • Bacterial skin infections: Presents as a variety of lesions from macules to pustules to ulcers with redness surrounding the lesion.
• Criterion: Symptoms
  • Fungal skin infections: Itching and pain.
  • Contact dermatitis: Itching and pain.
  • Bacterial skin infections: Irritation and pain.
• Criterion: Quantity/Severity
  • Fungal skin infections: Usually localized to one region of the body but can spread.
  • Contact dermatitis: Affects all areas of exposed skin but does not spread.
  • Bacterial skin infections: Usually localized to one region of the body but can spread.
• Criterion: Timing
  • Fungal skin infections: Variable onset.
  • Contact dermatitis: Variable onset from immediately after exposure to 3 weeks after contact.
  • Bacterial skin infections: Variable onset.
• Criterion: Cause
  • Fungal skin infections: Superficial fungal infection.
  • Contact dermatitis: Exposure to skin irritants or allergens.
  • Bacterial skin infections: Superficial bacterial infection.
• Criterion: Modifying Factors
  • Fungal skin infections: Treated with nonprescription astringents, antifungals, and nondrug measures to keep the area clean and dry.
  • Contact dermatitis: Treated with topical antipruritics, skin protectants, astringents, and nondrug measures to avoid reexposure.
  • Bacterial skin infections: Treated with prescription antibiotics.

Tinea Pedis

• Clinically, tinea pedis has four accepted variants; two or more of these types may overlap.