Fungal Skin Diseases

Histoplasmosis

Histoplasmosis, disseminated. Scattered erythematous papules and pustules in an HIV-infected individual with disseminated histoplasmosis.

Baby Yeast Infections

Thrush is a yeast infection that causes white patches in the mouth and on the tongue. Thrush is most common in babies and older adults, but it can occur at any age. In babies, it is easy to mistake thrush for milk or formula. It looks like cottage cheese or milk curds. Don't try to wipe away these patches, because you can make them red and sore. Some babies with thrush can be cranky and do not want to eat.

Pet Ringworm

Animals can also be affected by ringworm and may transmit the condition to humans. In this case, ringworm is an example of a zoonotic disease, or a disease transmitted from animals to humans. Although cats are affected by ringworm more than dogs, dogs are also commonly affected. In animals, ringworm causes raised, circular areas that frequently are crusted over and associated with hair loss. However, some infected cats may also carry the fungus without showing any symptoms. On the other hand, infected dogs almost always show the typical skin symptoms of ringworm. Studies have shown that up to 13% of human ringworm infections (tinea capitis) are caused by an organism that commonly causes ringworm in cats. Other studies have shown that in 30%-70% of households in which a cat develops ringworm, at least one person will develop the condition. Young children, the elderly, and people whose immune function is compromised for any reason are most susceptible to the infection. Other animals that can develop ringworm (and can transmit the infection to humans) include dogs, cows, goats, pigs, guinea pigs, and horses. As with transmission among humans, direct contact or contact with objects the infected animal has touched (such as bedding, grooming articles, saddles, furniture, carpeting, etc.) is responsible for spreading the infection. Ringworm is a treatable condition in both animals and humans. Topical (applied to the affected area) medication is the usual treatment for ringworm. In severe or resistant (not responding well to topical medications) infections, oral antifungal medications (taken by mouth) may be prescribed. If a pet has been infected with ringworm, it is important to thoroughly disinfect the home to rid the environment of any remaining fungal spores after treatment.

Candidiasis (Moniliasis)

The angles of the mouth are also the places where intertriginous conditions favor the overgrowth of ubiquitous C. albicans, streptococci, staphylococci, and other ordinarily saprophytic but facultatively pathogenic microorganisms. These conditions are not to be confused with vitamin deficiencies, which are often overdiagnosed. Perlèche is more likely to be a mixed infection with C. albicans and bacteria. Therefore, treatment should be with a preparation that contains both an antimonilial agent like nystatin and a topical antibiotic. Candidal cheilitis is more difficult to treat and requires persistent application of a candicidal agent. Candidiasis in children with immunologic deficiency is particularly difficult to treat.

Sporotrichosis

Sporotrichosis - Cutaneous infection with Sporothrix schenckii is a disease with worldwide distribution. The majority of cases are seen in Central and South America but outbreaks occur in the United States. The disease affects both children and adults and occurs when the causative fungus, in either contaminated soil or plant materials, contacts traumatized skin. This figure illustrates a somewhat less common form of the disease, fixed cutaneous sporotrichosis. The patient fell on rocks while playing in the country and sustained abrasions on an arm and elbow. Sporothrix schenckii was cultured from the crusted plaques in both locations. In this clinical form, the deep fungal infection remains confined to one area of the skin and has no tendency toward lymphatic spread.

Tinea Versicolor

This title designates a superficial fungal infection (tinea) that changes color (versicolor). The causative organism was originally called Malassezia furfur and is now called Pityrosporum orbiculare. Tinea versicolor typically causes numerous patchy scaling macules on the upper chest and back, proximal arms, and neck. Facial involvement may occur as shown. The lesions may be hypopigmented, as illustrated here, or brown-orange, depending on the skin color of the patient and the degree of recent sun exposure. The organism is believed to prevent either the formation of melanin or the transfer of melanosomes into keratinocytes. The formation of azelaic acid is another suggested mechanism for the resultant hypopigmentation. Although tinea versicolor usually makes its appearance after puberty, it can develop in childhood and is occasionally seen in breast-fed infants. Tinea versicolor is usually asymptomatic but may itch slightly. The organism cannot be cultured, but diagnosis is aided by the orange or brown glow of lesional skin under a Wood's light and by the “spaghetti and meatballs” appearance of clustered hyphae and spores on potassium hydroxide preparation.

Fungal Nail Infection

Nails that are infected with a fungus may become discolored (yellowish-brown or opaque), thick and brittle, and may separate from the rest of the nail. In some cases, the nail may crumble. The dark, moist, and warm environment of shoes can promote fungal growth. In addition, an injury to the nail can put you at risk for a fungal infection. Fungal nail infections are difficult to treat. Medications applied directly to the nail are available, but they only help a small number of fungal nail problems. Oral medications (pills) may need to be prescribed by your doctor. Treatment also may include periodic removal of the damaged nail tissue.

Athlete's Foot 2

Athlete's foot is a fungus that causes itching, redness, and cracking. Germs can enter through the cracks in your skin and cause an infection. Medicines that kill the fungus are used to treat athlete's foot. These medicines may be pills and/or creams applied directly to the problem area. Ask your doctor to recommend a medication for athlete's foot.

Athlete's Foot 1

Athlete's foot is caused by a fungus that grows on or in the top layer of skin. Fungi (plural of fungus) grow best in warm, wet places, such as the area between the toes. Athlete's foot spreads easily. You can get it by touching the toes or feet of a person who has it. But most often, people get it by walking barefoot on contaminated surfaces near swimming pools or in locker rooms. The fungi then grow in your shoes, especially if your shoes are so tight that air cannot move around your feet. Athlete's foot can make your feet and the skin between your toes burn and itch. The skin may peel and crack. Your symptoms can depend on the type of athlete's foot you have. Read more about athlete's foot.

Erythema Annulare Centrifugum

Erythema annulare centrifugum. Polycyclic lesion on the thigh of a child with a tinea capitis infection.

Tinea Capitis

Tinea capitis is also known as ringworm of the scalp. This fungal infection generally affects school-age children and may spread in schools. It appears as scalp scaling associated with bald spots usually showing broken-off hairs. Oral antibiotics are needed to penetrate the hair roots and cure the infection after which hair grows back.

Ringworm Tinea Unguium (Onychomycosis)

Ringworm - Tinea unguium (fungal infection of the nails) is somewhat uncommon during childhood. After puberty, its frequency increases with age. Usually, onychomycosis is associated with tinea pedis. Fungal culture of the nails is sometimes difficult but extremely important in confirming the diagnosis. Onychomycosis is the most difficult of the superficial fungal infections to treat because the nail plate is not penetrated by (most) topically applied agents. Systemic antifungal agents such as itraconazole and terbinafine appear effective in the treatment of onychomycosis. The illustrations show infection with dermatophytes. Note the distortion of nail plates. Infection by dermatophytes usually proceeds in a distal-toproximal direction. Infection of nails by C. albicans is different in that it is more acute (frequently purulent) and tends first to involve the lateral and proximal nail folds.

Ringworm Tinea Pedis

Ringworm - Superficial fungal infection of the feet is somewhat unique because of the location. Between the toes (most commonly the fourth and fifth), the condition appears as erythema, maceration, and scaling. In some cases, this may become secondarily infected. It is attended by itching or vague discomfort. On the sole and the lateral aspects of the feet, scattered pustules and vesicles with surrounding erythema and edema may occur. More commonly, there is persistent dry scale in a “moccasin” distribution with minimal inflammation.

Ringworm Tinea Corporis (Faciei)

Ringworm - Superficial fungal infections of the skin are among the most common of all pediatric dermatoses. Infection at the sites pictured here may also be termed tinea faciei. T. tonsurans, T. rubrum, and T. mentagrophytes are common pathogens. Cutaneous infection with zoophilic species, such as M. canis, usually results from close contact with a household pet. On the body, fungi lodge in the stratum corneum and do not invade lanugo hairs.

Ringworm of the Nails

Ringworm of the nails or tinea unguium is the most common fungus infection of the nails, also called onychomycosis. Onychomycosis makes the nails look white and opaque, thickened, and brittle. Those at increased risk for developing onychomycosis include: People with diabetes; People with disease of the small blood vessels (peripheral vascular disease); and Older women (perhaps because estrogen deficiency increases the risk of infection); and Women of any age who wear artificial nails (acrylic or "wraps"). Artificial nails increase the risk for onychomycosis because, when an artificial nail is applied, the nail surface is usually abraded with an emery board damaging it, emery boards can carry infection, and water can collect under the artificial nail creating a moist, warm environment favorable for fungal growth. An alternative name is dermatophytic onychomycosis.

Ringworm of the Hand

Ringworm may involve the hands, particularly the palms and the spaces between the fingers. It typically causes thickening (hyperkeratosis) of these areas, often on only one hand. Tinea manus is a common companion of tinea pedis (ringworm of the feet). It is also called tinea manuum.

Ringworm

Worms don't cause ringworm. Rather, this superficial skin infection, also known as tinea, is caused by fungi called dermatophytes. Fungi are microscopic organisms that can live off the dead tissues of your skin, hair, and nails, much like a mushroom can grow on the bark of a tree. Ringworm is characterized by a red ring of small blisters or a red ring of scaly skin that grows outward as the infection spreads. Though children are especially susceptible to catching ringworm, it can affect adults as well.

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