Fungal Infections

October 29, 2008

Fungus Infections of the Nails

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Fungus Infections of the Nails

What are fungal infections of the nails?

Fungal infections of the nails are common. The fungus grows in the nail bed, where the nail meets the skin. The fungus grows slowly and does not spread to internal organs. The main concern is the nail discoloration (usually yellow) and change in nail texture and growth. Nails can become crumbly, break easily, and grow irregularly. But because other nail conditions can mimic fungal infection, most doctors will confirm the diagnosis by sending a nail clipping for laboratory evaluation — especially if treatment is being considered.

Fungal infections are not commonly contagious or spread easily between people. The fungus grows in people whose bodies “allow” the fungus to become established without mounting an immune response to suppress the fungus. We know of no ways to boost your immune system to make fungal infections less likely. You may be able to prevent fungus infections by:

Keeping your feet dry, avoiding constant moisture

Avoid non porous, closed shoes made of synthetic materials

Wearing absorbent socks

Wearing water proof sandals when in public showers

What can be done about fungal nail infection?

Because the fungus grows slowly, it is hard to eliminate. The anti fungal medications that eliminate the fungus are strong, must be taken by mouth, and must be taken conscientiously for months in order to be effective. Each drug has potential side effects on other body organs (especially the liver, skin, or bone marrow). To monitor for side effects, periodic blood testing must be obtained, usually monthly, during the time you take the medication. Any symptoms suggesting organ damage should be reported immediately to your physician, such as: unusual fatigue, severe loss of appetite, nausea, yellow eyes, dark urine, pale stool, skin rashes, bleeding, enlarged lymph glands, or signs of infection.

Unfortunately, anti fungal creams applied directly to the nail cannot penetrate the nail bed to kill the fungus at its source, so they are not usually effective.

How effective are the medications at curing the fungus?

The anti fungal medications usually suppress the nail infection when taken as directed. Unfortunately, they cannot guarantee permanent cure. At least 1 in 5 patients (20%) and probably more will have a recurrence of the original nail infection at some time, and re-treatment with medication would be necessary.

Should I take medication to treat my fungal nail infection?

Doctors usually recommend treating fungal nail infections only when such infections cause secondary problems, like pain, recurring ingrown toenails, or secondary bacterial infections of the nails or skin. If the nail infection causes no symptoms, then doctors often will discourage treatment because of the potential side effects, the need to monitor the blood throughout therapy, and the high recurrence rate. Patients with liver or heart disease generally should not take these medications.

Some insurance companies require documentation of secondary problems beyond the mere presence of the fungal infection before they will cover the costs of the anti fungal medications.

April 2002

Acknowledgment and Thanks

Palo Alto Medical Foundation


What is Nail Fungus?

Also known as: Onychomycosis or Tinea Unguium

Nail fungus is made up of tiny organisms (Tinea Unguium) that can infect fingernails and toenails. The nails of our fingers and toes are very effective barriers. This barrier makes it quite difficult for a superficial infection to invade the nail. Once an infection has set up residence however, the same barrier that was so effective in protecting us against infection now works against us, making it difficult to treat the infection.

More than 35 million people in the United States get this fungus. The fungus lives underneath the nail. The nail provides a safe place for the fungus and protects it while it grows, since fungus like dark and damp places. This is why it’s hard to reach and stop nail fungus.

Nail polish and plastic or acrylic nails can trap moisture and fungi. Most often, nail fungus appears in the toenails because socks and shoes keep the toenails dark, warm, and moist. The toenails are 6 to 7 times more likely to be infected than fingernails. Fungi often cause the area around the base (and the sides) of the nail to become red and irritated. At first, the edges or base of the nail is affected. As it spreads, the nail and nail bed show changes. There is often mild discomfort, itchiness, or even pain around the cuticles (flesh surrounding the nails). Bleeding or detachment of the cuticles may occur. The nail can become discolored-yellow-green, dark yellow-brown, and sometimes white spots are seen. The nails thicken and develop abnormal grooves, lines, and tiny punched out holes.

Is it Contagious?

Yes, it can be. The organisms can sometimes spread from one person to another because these critters can live where the air is often moist and people’s feet are bare. This can happen in places like shower stalls, bathrooms, or locker rooms or it can be passed around on a nail file or emery board. So, don’t share them. Nail fungus may also spread from one of your nails to other nails.

How Do You Treat Nail Fungus?

The best treatment of course is prevention. Keep your nails cut straight across. If nails are hard to cut, soften by soaking in salt water (use 1 teaspoon per gallon of water and then dry well). Keep feet dry and well ventilated. Be careful with artificial nails and be selective about choosing your manicurist. Ask about how they sterilize their instruments. See a podiatrist or your health care provider if you see signs of fungus.

Topical creams applied directly to the infected site are often used for less serious infections. Visit the foot care section of your local drug store chain. Creams include Lotrimin, Monistat, Nizoral, Tinactin, and Lamisil. If the topical treatments fail, more potent medications can be taken orally if your health care provider thinks it is necessary. Oral medications may have side effects, so tell your health care provider about any other medications, including birth control like the pill or Depo-Provera, if you are prescribed an oral medication for fungus.

The nails can reveal a lot about the body’s internal health. Healthy nails are often a sign of good health, while bad nails are often a tip off to more serious problems. A high protein diet may help your nails grow stronger and healthier.

Cool Nurse

Fungal Sinusitis

Fungal Sinusitis

What Is A Fungus? Fungi are plant-like organisms that lack chlorophyll. Since they do not have chlorophyll, fungi must absorb food from dead organic matter. Fungi share with bacteria the important ability to break down complex organic substances of almost every type (cellulose) and are essential to the recycling of carbon and other elements in the cycle of life. Fungi are supposed to “eat” only dead things, but sometimes they start eating when the organism is still alive. This is the cause of fungal infections; the treatment selected has to eradicate the fungus to be effective.

In the past 30 years, there has been a significant increase in the number of recorded fungal infections. This can be attributed to increased public awareness, new immunosuppressive therapies (medications such as cyclosporine that “fool” the body’s immune system to prevent organ rejection) and overuse of antibiotics (anti-infectives).

When the body’s immune system is suppressed, fungi find an opportunity to invade the body and a number of side effects occur. Because these organisms do not require light for food production, they can live in a damp and dark environment. The sinuses, consisting of moist, dark cavities, are a natural home to the invading fungi. When this occurs, fungal sinusitis results.

There Are Four Types Of Fungal Sinusitis:

Mycetoma Fungal Sinusitis produces clumps of spores, a “fungal ball,” within a sinus cavity, most frequently the maxillary sinuses. The patient usually maintains an effective immune system, but may have experienced trauma or injury to the affected sinus(es). Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An anti-fungal therapy is generally not prescribed. Allergic Fungal Sinusitis (AFS) is now believed to be an allergic reaction to environmental fungi that is finely dispersed into the air. This condition usually occurs in patients with an immunocompetent host (possessing the ability to mount a normal immune response). Patients diagnosed with AFS have a history of allergic rhinitis, and the onset of AFS development is difficult to determine. Thick fungal debris and mucin (a secretion containing carbohydrate-rich glycoproteins) are developed in the sinus cavities and must be surgically removed so that the inciting allergen is no longer present. Recurrence is not uncommon once the disease is removed. Anti-inflammatory medical therapy and immunotherapy are typically prescribed to prevent AFS recurrence.

Note: A 1999 study published in the Mayo Clinic Proceedings asserts that allergic fungal sinusitis is present in a significant majority of patients diagnosed with chronic rhinosinusitis. The study found 96 percent of the study subjects with chronic rhinosinusitis to have a fungus in cultures of their nasal secretions. In sensitive individuals, the presence of fungus results in a disease process in which the body’s immune system sends eosinophils (white blood cells distinguished by their lobulated nuclei and the presence of large granules that attract the reddish-orange eosin stain) to attack fungi, and the eosinophils irritate the membranes in the nose. As long as fungi remain, so will the irritation.

Chronic Indolent Sinusitis is an invasive form of fungal sinusitis in patients without an identifiable immune deficiency. This form is generally found outside the US, most commonly in the Sudan and northern India. The disease progresses from months to years and presents symptoms that include chronic headache and progressive facial swelling that can cause visual impairment. Microscopically, chronic indolent sinusitis is characterized by a granulomatous inflammatory infiltrate (nodular shaped inflammatory lesions). A decreased immune system can place patients at risk for this invasive disease.
Fulminant Sinusitis is usually seen in the immunocompromised patient (an individual whose immunologic mechanism is deficient either because of an immunodeficiency disorder or because it has been rendered so by immunosuppressive agents). The disease leads to progressive destruction of the sinuses and can invade the bony cavities containing the eyeball and brain.

The recommended therapies for both chronic indolentand fulminant sinusitis are aggressive surgical removal of the fungal material and intravenous anti-fungal therapy.

American College of  Otolarynology – Head and Neck Surgery


Filed under: fungal infections — Tags: , , , , — patoconnor @ 1:40 pm


Clinical Features Symptomatic infection (50% of cases) usually presents as a flu-like illness with fever, chills, productive cough, myalgia, arthralgia and pleuritic chest pain. Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting the skin, bones, and genitourinary tract). Occasionally affects the meninges. Etiologic Agent Blastomyces dermatitidis. Reservoir Moist soil enriched with decomposing organic debris. Endemic in parts of the south-central, south-eastern and mid-western United States. Microfoci in Central and South America and parts of Africa. Incidence 1-2 cases per 100,000 population in areas with endemic disease. Sequelae Permanent lung damage with chronic disease. Mortality rate is about 5%. Transmission Inhalation of airborne conidia (spores) after disturbance of contaminated soil. Risk Groups Persons in areas with endemic disease with exposures to wooded sites (e.g., farmers, forestry workers, hunters, and campers). Surveillance Reportable in a few states in areas with endemic disease. No national surveillance exists. Challenges

Improving understanding of sources and routes of transmission from the environment. Developing more sensitive and specific tests for diagnosis.






Blastomycosis (North American blastomycosis, Gilchrist’s disease) is infection caused by the fungus Blastomyces dermatitidis.

Spores of Blastomyces probably enter the body through the airways when they are inhaled. Thus, blastomycosis primarily affects the lungs (see Pneumonia: Blastomycosis) but occasionally spreads through the bloodstream to other areas of the body, including the skin. Most infections occur in the United States, chiefly in the Southeast and the Mississippi River valley. Infections have also occurred in widely scattered areas of Africa. Men between the ages of 20 and 40 years are most commonly infected. Unlike most other fungal infections, blastomycosis is not more common in people with AIDS.

Symptoms and Diagnosis

Blastomycosis of the lungs begins gradually with a fever, chills, and drenching sweats. Chest pain, difficulty breathing, and a cough that may or may not bring up sputum may also develop. The lung infection usually progresses slowly, although it sometimes gets better without treatment.

When blastomycosis spreads, it can affect many areas of the body, but the skin, bones, and genitourinary tract are the most common sites. A skin infection begins as very small, raised bumps (papules), which may contain pus. Raised, warty patches then develop, surrounded by tiny, painless abscesses (collections of pus). Painful swelling in the bones may occur. Also, men may experience painful swelling of the epididymis (a cordlike structure attached to the testes) or discomfort from an infection of the prostate gland (prostatitis).



Blastomycosis A doctor diagnoses blastomycosis by sending a sample of sputum or infected tissue to a laboratory to be examined under a microscope and cultured.


Prognosis and Treatment

Blastomycosis may be treated with intravenous amphotericin Bor oral itraconazoleSome Trade Names
. With treatment, the person begins to feel better fairly quickly, but the drug must be continued for months. Without treatment, the infection slowly worsens and leads to death.


Cryptococcal meningitis

Cryptococcal meningitis

Alternative names    Return to top

Cryptococcal meningitis

Cryptococcal meningitis is an infection of the meninges (the membranes covering the brain and spinal cord) caused by Cryptococcus neoformans.

Causes, incidence, and risk factors    Return to top

Cryptococcus neoformans is a yeast that is found in soil around the world. Cryptococcal meningitis most often affects people with compromised immune systems. Risk factors include AIDS, lymphoma, and diabetes. It occurs in 5 out of 1 million people.

Symptoms    Return to top

  • Headache
  • Fever
  • Nausea and vomiting
  • Stiff neck
  • Sensitivity to light (photophobia)
  • Mental status change
  • Hallucinations
  • Signs and tests    Return to top

  • In order to diagnose cryptococcal meningitis, a lumbar puncture (spinal tap) must be performed. This test involves taking a sample of fluid from the spinal column (called cerebrospinal fluid or CSF). The following tests on the CSF allow the diagnosis of cryptococcal meningitis: 

  • CSF stains may show the yeast
  • CSF culture grows cryptococcus
  • CSF may be positive for cryptococcus antigen Also, a blood test, the serum cryptococcal antigen test, can be sensitive in diagnosing cryptococcus infection, especially in AIDS patients. 
  • Treatment    Return to top

    Antifungal medications are used to treat this form of meningitis. Intravenous therapy with amphotericin B is the most common treatment. Intrathecal (injection into the spinal cord) medication is sometimes given to people who do not respond to intravenous therapy. An oral medication, fluconazole, in high doses may also be effective against this infection. 

    Expectations (prognosis)    Return to top

    Maintenance therapy must be given to people with AIDS to prevent relapse. 

    Complications    Return to top

    Obstructive hydrocephalus is a complication. This occurs when the CSF is not properly drained, resulting in rising pressures on the brain that can cause temporary or permanent brain damage. Amphotericin B can have severely unpleasant side effects. 

    Calling your health care provider    Return to top

    Call the local emergency number (such as 911) or go to the emergency room if you have symptoms suggestive of meningitis or if you are being treated for meningitis and symptoms worsen. 

    If you have difficulty breathing or swallowing, paralysis, numbness, or sensory or mental state changes, get to the emergency room as quickly as possible. 


    Update Date: 7/14/2004

    Medline Plus


    Cryptococcal Meningitis What is Cryptococcal meningitis?

    Cryptococcal meningitis is a life-threatening infection that can occur if there has been exposure to a fungus called Cryptococcus neoformans. This fungus is found in the environment worldwide, particularly in soil contaminated with bird droppings. This fungus enters the body most commonly through the lungs. Infection does not usually appear until a person’s CD4 counts have dropped below 100. Cryptococcal meningitis can not be passed from one person to another. This fungus most commonly affects the brain, causing the condition called meningitis. Meningitis is an infection and swelling of the lining of the brain and spinal cord. Cryptococcus can also cause infections of the lungs, skin and prostate gland.

    Symptoms: What do I look for?

    Cryptococcal meningitis may be very slow in developing, so at first, very vague symptoms may appear: mild headache, fever, nausea.

    • As the infection progresses, more symptoms will appear if it is not treated:
    • severe headache, nausea with vomiting, blurred vision and/or sensitivity to bright light, stiff neck, seizures, confusion, behaviour changes, coma.
    • Meningitis can be mistaken for other types of brain infections.

    Special tests are needed to confirm Cyptococcal meningitis:

    Lumbar puncture (spinal tap): taking fluid from your spinal column through a needle in your back. This fluid in then sent for special tests. Blood tests: to check whether you have been exposed to the fungus.

    Can Cryptococcal meningitis be prevented?

    Although it is impossible to avoid exposure to this common fungus, people with advanced HIV disease should wear gloves when gardening and generally be careful around bird roosts. At present, there are no proven treatments to prevent this infection, however, studies are in progress. Early detection of the disease and reporting your symptoms is important so that proper treatment can be started.

    How is Cryptococcal meningitis treated?

    When a person is diagnosed with cryptococcal meningitis, treatment with antifungals begins immediately. These medications are usually given intravenously (directly into the vein). Amphotericin B and fluconazole (Diflucan) are the most common drugs used to treat the infection. Once the infection has been treated, it is recommended that the person remain on one of the these drugs for the rest of their lives to prevent the infection from returning again.


    Philips, Peter, (1994) . “Fungal Infections in AIDS Patients”, Grand Rounds in Infectious Diseases, 4, (10), 5-11.

    Sande, Merle & Volberding, Paul, (1992). The Medical Management of AIDS, 3rd ed. Philadelphia: W.B. Saunders Co. White, Mary &

    Armstrong, Donald, (1994). “Cryptococcosis” in Infectious Disease Clinics of North America, 8, (2), 383-398.



    Candida Infections

    Filed under: fungal infections — Tags: , , , , , , — patoconnor @ 1:30 pm

    Candida Infections

    What Is It?

    Candidiasis is an infection caused by Candida fungi, especially Candida albicans. These fungi are found almost everywhere in the environment. Some may live harmlessly along with the abundant “native” species of bacteria that normally colonize the mouth, gastrointestinal tract and vagina. Usually, Candida is kept under control by the native bacteria and by the body’s immune defenses. If the native bacteria are decreased by antibiotics or if the person’s immune system is weakened by illness (especially AIDS or diabetes), malnutrition, or certain medications (corticosteroids or anticancer drugs),

    Candida fungi can multiply to cause symptoms.  Candida infections can cause occasional symptoms in healthy people.

    Candidiasis can affect many parts of the body, causing localized infections or larger illness, depending on the person and his or her general health.

    Types of candidiasis include:

  • Thrush — Thrush is the common name for a mouth infection caused by the Candida albicans fungus. It affects moist surfaces around the lips, inside the cheeks, and on the tongue and palate. Thrush is common in people with diseases such as cancer and AIDS, which both suppress the immune system. Thrush can develop in people with normal immune systems, too, particularly in people with diabetes or long-lasting irritation from dentures.

  • Esophagitis Candida infections of the mouth can spread to the esophagus, causing esophagitis. This infection is most common in people with AIDS and people receiving chemotherapy for cancer.

  • Cutaneous (skin) candidiasisCandida can cause skin infections, including diaper rash, in areas of skin that receive little ventilation and are unusually moist. Some common sites include the diaper area; the hands of people who routinely wear rubber gloves; the rim of skin at the base of the fingernail, especially for hands that are exposed to moisture; areas around the groin and in the crease of the buttocks; and the skin folds under large breasts.

  • Vaginal yeast infections — Vaginal yeast infections are not usually transmitted sexually. During a lifetime, 75% of all women are likely to have at least one vaginal Candida infection, and up to 45% have 2 or more. Women may be more susceptible to vaginal yeast infections if they are pregnant or have diabetes. The use of antibiotics or birth control pills can promote yeast infections. So can frequent douching.Deep candidiasis (for example, candida sepsis) — In deep candidiasis, Candida fungi contaminate the bloodstream and spread throughout the body, causing severe infection. This is especially common in newborns with very low birth weights and in people with severely weakened immune systems or severe medical problems. In these people, Candida fungi may get into the bloodstream through skin catheters, tracheostomy sites, ventilation tubing, or surgical wounds. Deep candidiasis also can occur in healthy people if Candida fungi enter the blood through intravenous drug abuse, severe burns or wounds caused by trauma.


    Candidiasis causes different symptoms, depending on the site of infection.

  • Thrush — Thrush causes curdlike white patches inside the mouth, especially on the tongue and palate and around the lips. If you try to scrape off this whitish surface, you will usually find a red, inflamed area, which may bleed slightly. There may be cracked, red, moist areas of skin at the corners of the mouth. Sometimes thrush patches are painful, but often they are not.
  • EsophagitisCandida esophagitis may make swallowing difficult or painful, and it may cause chest pain behind the breastbone (sternum).
  • Cutaneous candidiasis — Cutaneous candidiasis causes patches of red, moist, weepy skin, sometimes with small pustules nearby.
  • Vaginal yeast infections — Vaginal yeast infections may cause the following symptoms: vaginal itch and/or soreness; a thick vaginal discharge with a texture like soft or cottage cheese; a burning discomfort around the vaginal opening, especially if urine touches the area; and pain or discomfort during sexual intercourse.
  • Deep candidiasis — When Candida spreads to the bloodstream, it may cause a wide range of symptoms, from unexplained fever to shock and multiple organ failure. Diagnosis

    Your doctor will ask about your medical history, including diabetes, cancer, HIV, and other chronic illnesses. He or she also will ask about your diet and about your recent use of antibiotics or medications that can suppress the immune system. If your doctor suspects cutaneous candidiasis, he or she may ask how you care for your skin and about conditions that expose your skin to excessive moisture, such as using rubber gloves.

    Often, your doctor can diagnose thrush, cutaneous candidiasis, or vaginal yeast infection by a simple physical examination. However, if the diagnosis is uncertain, your doctor may scrape the surface to obtain cells to examine under a microscope or may culture a skin sample to identify fungus or yeast. A culture is especially helpful if you have a yeast infection that returns after treatment. In this case, the culture can help identify whether the yeast is resistant to usual antibiotic treatments. If your doctor suspects that you have an undiagnosed medical illness that increases your risk of candidiasis — such as diabetes, cancer or HIV — blood tests or other procedures may be necessary.

    To diagnose Candida esophagitis, your doctor will examine your esophagus with an endoscope, a flexible instrument that is inserted into your throat and allows your doctor look at the area directly. During this examination, called endoscopy, your doctor will take a sample of tissue (either a biopsy or a “brushing”) from your esophagus to be examined in a laboratory.

    To diagnose deep candidiasis, your doctor will draw a sample of blood to be checked in a laboratory for the growth of Candida fungi or other infectious agents.

    Expected Duration

    In otherwise healthy people who have thrush, cutaneous candidiasis, or vaginal yeast infections, Candida infections usually can be eliminated with a short treatment (sometimes a single dose) of antifungal dication. However, in people with AIDS or other diseases that weaken the immune system, Candida infections can be difficult to treat and can return after treatment. In people with weakened immune systems, candidiasis can be life threatening if it passes into the blood and spreads to vital organs.


    In general, you can prevent most Candida infections by keeping your skin clean and dry, by using antibiotics only as your doctor directs, and by following a healthy lifestyle, including proper nutrition. People with diabetes should try to keep their blood sugar under tight control.

    If you have HIV or another cause of recurrent episodes of thrush, antifungal drugs, such as clotrimazole (Lotrimin, Mycelex), can help to minimize flare-ups.


    Treatment of candidiasis varies, depending on the area affected:

  • Thrush — Doctors treat thrush with topical, antifungal medications such as nystatin (Mycostatin and others) and clotrimazole. For mild cases, a liquid version of nystatin can be swished in the mouth and swallowed, or a clotrimazole lozenge can be dissolved in the mouth. For more severe cases, ketoconazole (Nizoral) or fluconazole (Diflucan) can be taken once a day by mouth.
  • Esophagitis — Candida esophagitis is treated with ketoconazole, itraconazole (Sporanox) or fluconazole. (Fluconazole is the most effective medication for people with HIV/AIDS).
  • Cutaneous candidiasis — This skin infection can be effectively treated with a variety of antifungal powders and creams. The affected area must be kept clean and dry and protected from chafing.
  • Vaginal yeast infections — Vaginal yeast infections can be treated with antifungal medications that are applied directly into the vagina as tablets, creams, ointments or suppositories. These include butoconazole (Femstat), clotrimazole (Gyne-Lotrimin), miconazole (Monistat 3 and others), nystatin (Mycostatin and others), tioconazole (Trosyd) and terconazole (Vagistat-1). A single dose of oral fluconazole can be used, although this treatment is not recommended during pregnancy. Sex partners usually do not need to be treated.
  • Deep candidiasis — This infection is usually treated with intravenous amphotericin B (Abelcet) or fluconazole. When To Call A Professional

    Call your doctor whenever you have symptoms of candidiasis, especially if you have a chronic illness or a weakened immune system caused by cancer, HIV or medications that suppress the immune system.


    Typically, in otherwise healthy people with superficial candidiasis, a properly treated infection goes away without leaving permanent damage. Candidiasis is unlikely to return as long as the person remains healthy and well nourished. In people with chronic illnesses or weakened immune systems, episodes of candidiasis may be more resistant to treatment and may return after treatment ends. In people with deep candidiasis, those who are diagnosed quickly and treated effectively have the best prognosis, especially if their infection can be stopped before it spreads to major organs.

    Additional Info

    Centers for Disease Control and Prevention (CDC)
    1600 Clifton Road
    Atlanta, GA 30333
    Phone: 404-639-3534
    Toll-Free: 1-800-311-3435

    National Oral Health Information Clearinghouse
    1 NOHIC Way
    Bethesda, MD 20892-3500
    Phone: 301-402-7364
    Fax: 301-907-8830

    Last updated August 20, 2005



    Getting Rid of Yeast Infections

    by Judith Levine Willis

    It’s an itchy feeling you might hardly notice at first.

    Maybe, you muse, it’s just that your jeans are too tight.

    Actually, tight jeans may have something to do with it. But if the itch keeps getting itchier, even when your jeans have been off for awhile, then there’s something else involved.

    That something else could very well be a fungus whose technical name is Candida, and which causes what is often called a “yeast” infection. Such infections are most common in teenage girls and women aged 16to 35, although they can occur in girls as young as 10 or 11 and in older women (and less often, in men and boys as well). You do not have to be sexually active to get a yeast infection.

    The Food and Drug Administration now allows medicines that used to be prescription-only to be sold without a prescription to treat vaginal yeast infections that keep coming back. But before you run out and buy one, if you’ve never been treated for a yeast infection you should see a doctor. Your doctor may advise you to use one of the over-the-counter products or may prescribe a drug called Diflucan (fluconazole). FDA recently approved the drug, a tablet taken by mouth, for clearing up yeast infections with just one dose.

    Though itchiness is a main symptom of yeast infections, if you’ve never had one before, it’s hard to be sure just what’s causing your discomfort. After a doctor makes a diagnosis of vaginal yeast infection, if you should have one again, you can more easily recognize the symptoms that make it different from similar problems. If you have any doubts, though, you should contact your doctor.

    In addition to intense itching, another symptom of a vaginal yeast infection is a white curdy or thick discharge that is mostly odorless. Although some women have discharges midway between their menstrual periods, these are usually not yeast infections, especially if there’s no itching.

    Other symptoms of a vaginal yeast infection include:

    • soreness
    • rash on outer lips of the vagina
    • burning, especially during urination.

    It’s important to remember that not all girls and women experience all these symptoms, and if intense itching is not present it’s probably something else. Candida is a fungus often present in the human body. It only causes problems when there’s too much of it. Then infections can occur not only in the vagina but in other parts of the body as well–and in both sexes. Though there are four different types of Candida that can cause these infections, nearly 80 percent are caused by a variety called Candida albicans.

    Many Causes

    The biggest cause of Candida infections is lowered immunity. This can happen when you get run down from doing too much and not getting enough rest. Or it can happen as a result of illness.

    Though not usual, repeated yeast infections, especially if they don’t clear up with proper treatment, may sometimes be the first sign that a woman is infected with HIV, the virus that causes AIDS.

    FDA requires that over-the-counter (OTC) products to treat yeast infections carry the following warning:

    “If you experience vaginal yeast infections frequently (they recur within a two-month period) or if you have vaginal yeast infections that do not clear up easily with proper treatment, you should see your doctor promptly to determine the cause and receive proper medical care.”

    Repeated yeast infections can also be caused by other, less serious, illnesses or physical and mental stress. Other causes include:

    • use of antibiotics and some other medications, including birth control pills
    • significant change in the diet
    • poor nutrition
    • diabetes
    • pregnancy.

    Some women get mild yeast infections towards the end of their menstrual periods, possibly in response to the body’s hormonal changes. These mild infections sometimes go away without treatment as the menstrual cycle progresses. Pregnant women are also more prone to develop yeast infections. Sometimes hot, humid weather can make it easier for yeast infections to develop. And wearing layers of clothing in the winter that make you too warm indoors can also increase the likelihood of infection.

    “Candida infections are not usually thought of as sexually transmitted diseases,” says Renata Albrecht, M.D., of FDA’s division of anti-infective drug products. But, she adds, they can be transmitted during sex.

    The best way not to have to worry about getting yeast infections this way is not to have sex. But if you do have sex, using a condom will help prevent transmission of yeast infections, just as it helps prevent transmission of more commonly sexually transmitted diseases, including HIV infection, and helps prevent pregnancy. Teens should always use a latex condom if they have sex, even if they are also using other forms of birth control. (See “On the Teen Scene: Preventing STDs” in the June 1993 FDA Consumer.)

    If one partner has a yeast infection, the other partner should also be treated for it. A man is less likely than a woman to be aware of having a yeast infection because he may not have any symptoms. When symptoms do occur, they may include a moist, white, scaling rash on the penis, and itchiness or redness under the foreskin. As with females, lowered immunity, rather than sexual transmission, is the most frequent cause of genital yeast infections in males.

    OTC Products

    The OTC products for vaginal yeast infections have one of four active ingredients: butoconazole nitrate (Femstat 3), clotrimazole (Gyne-Lotrimin and others), miconazole (Monistat 7 and others), and tioconazole (Vagistat). These drugs are in the same anti-fungal family and work in similar ways to break down the cell wall of the Candida organism until it dissolves. FDA approved the switch of Femstat 3 from prescription to OTC status December 1996 and a similar switch for Vagistat in February 1997. The others have been available OTC for a few years.

    When you visit the doctor the first time you have a yeast infection, you can ask which product may be best for you and discuss the advantages of the different forms the products come in: vaginal suppositories (inserts) and creams with special applicators. Remember to read the warnings on the product’s labeling carefully and follow the directions.

    Symptoms usually improve within a few days, but it’s important to continue using the medication for the number of days directed, even if you no longer have symptoms.

    Contact your doctor if you have the following:

    • abdominal pain, fever, or a foul-smelling discharge
    • no improvement within three days
    • symptoms that recur within two months.

    OTC products are only for vaginal yeast infections. They should not be used by men or for yeast infections in other areas of the body, such as the mouth or under the fingernails. Candida infections in the mouth are often called “thrush.” Symptoms include creamy white patches that cover painful areas in the mouth, throat, or on the tongue. Because other infections cause similar symptoms, it’s important to go to a doctor for an accurate diagnosis.

    Wearing artificial fingernails increases the chance of getting yeast infections under the natural fingernails. Fungal infections start in the space between the artificial and natural nails, which become discolored. Treatment for these types of infections–as well as those that occur in other skin folds, such as underarms or between toes–require different products, most of which are available only with a doctor’s prescription.

    Knowing the causes and symptoms of yeast infections can help you take steps–such as giving those tight jeans a rest–to greatly reduce the chances of getting an infection.

    And, if sometimes prevention isn’t enough, help is easily at hand from your doctor and pharmacy.

    Judith Levine Willis is editor of FDA Consumer.


  • Jock Itch Tinea Cruris

    Jock Itch Tinea Cruris

    Jock itch, also known as tinea cruris, is a fungal infection of the skin in the groin. The warm, moist environment is the perfect place for the fungus to grow. Anything that enhances that environment puts the person at risk of getting jock itch. Therefore, wearing sweaty, wet clothing in the summer time or wearing several layers of clothing in the wintertime causes an increased incidence of jock itch. Men are affected more often than women.

    The Jock Itch Fungus
    The fungus that most commonly causes jock itch is called Trichophyton rubrum. It also causes fungal infections of the toes and body. Under the microscope, this fungus looks like translucent, branching, rod-shaped filaments or hyphae. The width of the hyphae is uniform throughout which helps distinguish it from hair, which tapers at the end.

    Some hyphae appear to have bubbles within their walls, also distinguishing them from hair. Under most conditions these fungi inhabit only the dead skin cells of the epidermis.

    Jock Itch Appearance
    The rash of jock itch starts in the groin fold usually on both sides. If the rash advances, it usually advances down the inner thigh. The advancing edge is redder and more raised than areas that have been infected longer. The advancing edge is usually scaly and very easily distinguished or well demarcated. The skin within the border turns a reddish-brown and loses much of its scale. Jock itch caused by T. rubrum does not involve the scrotum or penis. If those areas are involved, the most likely agent is Candida albicans, the same type of yeast that causes vaginal yeast infections.

    Rashes Similar to Jock Itch
    There are other rashes of the groin that can cause symptoms similar to jock itch. The first is called
    intertrigo which is a red, macerated rash at the groin fold not caused by a fungus. It is seen many times in obese patients and caused by moist skin rubbing against moist skin. The skin cracks and breaks down in lines called fissures, which can be very painful. These fissures can get secondarily infected with fungi or bacteria. The edge of the rash usually does not advance until much later in the life of the rash.

    The other condition that mimics tinea cruris is called erythrasma. This is a bacterial infection that affects the groin and advances down the inner thigh similar to tinea cruris. However, the rash of erythrasma is flat and more brown than red throughout the affected area. It also does not have any scale or blisters.

    Jock Itch Diagnosis
    The best way to diagnose tinea cruris is to look for hyphae under the microscope, a
    KOH test. The skin is scraped with a scalpel or glass slide causing dead skin cells to fall off onto a glass slide. A few drops of Potassium hydroxide (KOH) are added to the slide and the slide is heated for a short time. The KOH dissolves the material binding the skin cells together releasing the hyphae, but it does not distort the cell or the hyphae. Special stains such as Chlorazol Fungal Stain, Swartz Lamkins Fungal Stain, or Parker’s blue ink can be used to help visualize the hyphae better.

    Jock Itch Treatment
    Jock itch is best treated with topical creams or ointments since the fungus only affects the top layer of skin. Many of the antifungal medications require a prescription, but there are three that can be bought over-the-counter (OTC). The OTC antifungals are tolnaftate (Tinactin), clotrimazole (Lotrimin), and miconazole (Micatin). Creams used to treat jock itch should be applied twice a day for at least two weeks. Application can be stopped after the rash has been gone for one week. Creams should be applied to the rash and also at least two finger widths beyond the rash. Many people with jock itch also have athlete’s foot and these same creams can be applied to the feet. However, treatment of athlete’s foot can take up to four weeks. If the rash is very red and itchy, especially if it has blisters at the edge, a topical steroid such as hydrocortisone can be applied also. Steroids should not be used in the groin alone without consulting a health care provider since steroids alone can make the rash of jock itch much worse.

    Jock Itch Prevention
    To prevent jock itch from occurring or re-occurring, several measures may be taken.

    • Wear loose fitting clothing made of cotton or synthetic materials designed to wick moisture away from the surface.
    • Avoid sharing clothing and towels or washcloths.
    • Allow the groin to dry completely after showering before covering with clothes.
    • Antifungal powders or sprays may be used once a day to prevent infection.


    Jock Itch

    Game over! It was a hard-fought match, and you’ve just won in the final seconds. Now, as you bask in the afterglow of sweet victory, you think about all the great things you’re going to get from your sweaty efforts – admiring glances, bragging rights, a medal, a trophy, maybe even a mention in the local paper. But suddenly, your celebration is interrupted. Something’s not quite right. You’re feeling a little itchy and uncomfortable in a strange area due south. And it’s starting to burn. Yes, it’s something else you got for your athletic efforts, something you really didn’t expect and really didn’t want – jock itch.

    What Is Jock Itch?
    Jock itch is a pretty common fungal infection of the groin and upper thighs. It’s part of a group of fungal skin infections called tinea (pronounced: tih-nee-uh), and it’s related to athlete’s foot and ringworm (by the way, ringworm isn’t really a worm – it’s a fungus). The medical name for all of these types of fungal infections is a tinea infection, and the medical name for jock itch is tinea cruris (pronounced: tih-nee-uh krur-us).

    Jock itch, like other tinea infections, is caused by several types of mold-like fungi called dermatophytes (pronounced: dur-mah-tuh-fites). All of us have microscopic fungi and bacteria living on our bodies, and dermatophytes are among them. Dermatophytes live on the dead tissues of your skin, hair, and nails and thrive in warm, moist areas like the insides of the thighs. So, when your groin area gets sweaty and isn’t dried properly, it provides a perfect environment for the fungi to multiply and thrive.

    Who Gets Jock Itch?
    You don’t have to be a jock to get an itch in your groin area. Jock itch is so named because mostly athletes or “jocks” get it, but it can affect anyone who tends to sweat a lot. It most often affects guys, but girls can get it, too. Certain factors can make jock itch more likely to develop, like lots of sweating while playing sports, hot and humid weather, friction from wearing tight clothes for extended periods (like bathing suits), sharing clothes with others, diabetes mellitus, or obesity.

    What Are the Signs and Symptoms?
    Jock itch is usually less severe than other tinea infections, but can it last for weeks or months without treatment. Symptoms of jock itch include:

    • a circular, red, raised rash with elevated edges
    • itching, chafing, or burning in the groin, thigh, or anal area
    • skin redness in the groin, thigh, or anal area
    • flaking, peeling, or cracking skin

    How Do I Get Rid of It?
    Jock itch usually responds to self-care, and using over-the-counter antifungal creams and sprays will probably clear it up, though prescription antifungal creams are sometimes required. Be sure to:

    • Wash, then dry the area using a clean towel.
    • Apply the antifungal cream, powder, or spray as directed on the label.
    • Change your clothes, especially your underwear, every day.

    It’s important to continue this treatment for 2 weeks, even if symptoms disappear, to prevent the infection from recurring. If these steps don’t work, it’s a good idea to see a doctor. Sometimes, a doctor may need to prescribe a stronger antifungal cream, spray, or pill.

    Can I Prevent Jock Itch?
    Good hygiene is the most important thing that helps prevent jock itch. Keep the area as dry as possible by always using a clean towel after showering or swimming (also remember to avoid sharing towels). If you play sports and wear an athletic supporter, make sure you wash it as often as possible.

    Jock itch is pretty common, but can be avoided through proper care and attention. Be sure to keep your groin area clean and dry, especially after strenuous and sweaty activity. If you do get jock itch, remember that it almost always goes away on its own.

    Updated and reviewed by: Eliot N. Mostow, MD
    Date reviewed: May 2004
    Originally reviewed by:
    Patrice Hyde, MD


    Oral Thrush

    Filed under: fungal infections — Tags: , , , , , , , — patoconnor @ 1:25 pm

    Oral Thrush


    Oral thrush is a condition in which the fungus Candida albicans grows out of control. Like most healthy people, you probably have small amounts of the fungus in your mouth and digestive tract and on your skin. You can’t see the fungus and normally won’t know it’s there — it usually doesn’t cause problems because normal bacteria (flora) in your body keep its growth in check. But when this balance is disturbed — by medications or illness — Candida can grow out of control, leading to problems such as diaper rash and vaginal yeast infections as well as oral thrush.

    Oral thrush causes creamy white lesions, usually on your tongue or inner cheeks. The lesions can be painful and may bleed slightly when you scrape them or brush your teeth. Sometimes oral thrush may spread to the roof of your mouth, your gums, tonsils or the back of your throat.

    Although oral thrush can affect anyone, it occurs most often in babies and toddlers, older adults, and people whose immune systems have been compromised by illness or medications. Oral thrush is a minor problem for healthy children and adults, but for those with weakened immune systems, symptoms of oral thrush may be more severe, widespread and difficult to control.

    Signs and symptoms CLICK TO ENLARGE Photograph showing white, creamy patches of oral thrush on the tongue Oral thrush

    Oral thrush usually produces creamy white lesions on your tongue and inner cheeks and sometimes on the roof of your mouth, gums and tonsils. The lesions, which resemble cottage cheese, can be painful and may bleed slightly when rubbed or scraped. Although signs and symptoms often develop suddenly, they may persist for a long period of time.

    In severe cases, the lesions may spread downward into your esophagus — the long, muscular tube stretching from the back of your mouth to your stomach (Candida esophagitis). Signs and symptoms of Candida esophagitis may include:

    • Pain or difficulty swallowing
    • A sensation of food sticking in your throat or the middle of your chest
    • Possible fever if the infection spreads beyond your esophagus

    Symptoms in infants and breast-feeding mothers
    Healthy newborns with oral thrush usually develop symptoms during the first few weeks of life. In addition to the distinctive white mouth lesions, infants may have trouble feeding or be fussy and irritable. They can also pass the infection to their mothers during breast-feeding. Women whose breasts are infected with Candida may experience the following signs and symptoms:

    • Unusually red or sensitive nipples
    • Taut, shiny skin on the areola
    • Unusual pain during nursing or painful nipples between feedings
    • Stabbing pains deep within the breast  


    Microorganisms such as viruses, bacteria and fungi are everywhere, including in and on your own body. In general, the relationship between you and the microorganisms in your body is mutually beneficial. You provide nutrition, protection and transportation for them, while they stimulate your immune system, synthesize essential vitamins,, and help protect against harmful viruses and bacteria.

    But your relationship to microorganisms in the world at large is more complex. Some microbes are highly beneficial, whereas others — such as those that cause malaria and meningitis — can be deadly. For that reason, your immune system works to repel harmful invading organisms while maintaining a balance between “good” and “bad” microbes that normally inhabit your body.

    But sometimes these protective mechanisms fail. Oral thrush and other Candida infections occur when your immune system is weakened by disease or drugs such as prednisone, or when antibiotics disturb the natural balance of microorganisms in your body.

    These illnesses may make you more susceptible to oral thrush infection:

    • Chronic mucocutaneous candidiasis. Usually affecting children younger than age 3, thisgroup of rare disorders is marked by a chronic Candida infection of the mouth and fingernails and of the skin on the scalp, trunk, hands and feet. Scaly, crusted lumps known as granulomas also may develop in the mouth or on the nails and skin. Adults occasionally develop the disorder — usually as a result of a tumor on the thymus gland (thyoma).
    • HIV/AIDS. The human immunodeficiency virus (HIV) — the virus that causes AIDS — damages or destroys the cells of your immune system, making you more susceptible to opportunistic infections your body would normally resist. One of these opportunistic infections is oral thrush. Thrush is rare in the early stage of AIDS, usually appearing only when counts of helper T cells — one of the key cells in the immune system — fall below 350. Although oral thrush is the least serious of the fungal infections that can affect people with HIV, it may be an indication that HIV is worsening. Candida esophagitis, which occurs when thrush spreads to the esophagus, generally develops when T cell counts are 200 or less and is considered an AIDS-defining illness — an opportunistic illness that indicates a person with HIV is developing AIDS.
    • Cancer. If you’re dealing with cancer, your immune system is likely to be weakened both from the disease and from treatments such as chemotherapy and radiation, increasing the risk of Candida infections such as oral thrush.
    • Diabetes mellitus. If you don’t know you have diabetes or the disease isn’t well controlled, your saliva may contain large amounts of sugar, which encourages the growth of Candida.
    • Vaginal yeast infections. It’s estimated that three out of every four women will have a vaginal yeast infection (Candida vulvovaginitis) at least once before menopause. Vaginal yeast infections are caused by the same fungus that causes oral thrush. Although a yeast infection isn’t dangerous, a pregnant woman can pass the fungus to her baby during delivery. As a result, her newborn may develop oral thrush within the first several weeks after birth. Up to 5 percent of healthy newborns with oral thrush are infected through mother-to-child transmission.
    • Dry mouth (xerostomia). This occurs when the salivary glands don’t produce enough moisture. Dry mouth disrupts the balance of normal microorganisms in your mouth, increasing your risk of oral thrush. Although not itself a disease, dry mouth can be a symptom of certain illnesses, including Sjogren’s syndrome — an autoimmune disease that causes an extremely dry mouth and eyes. Bone marrow transplants, stress or anxiety, depression, and certain nutritional deficiencies also can cause a dry mouth. So can chemotherapy, radiation to the head and neck area and hundreds of medications — especially antidepressants, pain and high blood pressure drugs, tranquilizers, diuretics and antihistamines.

    Risk factors

    Anyone can develop oral thrush, but the infection is especially common in infants and toddlers whose immune systems aren’t fully developed. In addition, babies can pass the infection to their mothers during breast-feeding.

    You’re also more likely to develop oral thrush if you:

    • Are an older adult
    • Have a compromised immune system
    • Use corticosteroids, antibiotics or birth control pills
    • Smoke
    • Wear dentures

    Screening and diagnosis

    If you or your baby develops painful white lesions inside the mouth, see your doctor or dentist. Oral thrush can usually be diagnosed simply by looking at the lesions, but sometimes a small sample is examined under a microscope to confirm the diagnosis.

    If thrush develops in older children or adolescents who have no other risk factors, seek medical care. An underlying condition such as diabetes may be the cause. In that case, your doctor will perform a thorough physical exam as well as recommend certain blood tests to help find the source of the problem.

    Thrush that extends into the esophagus can be serious. To help diagnose this condition, your doctor may ask you to have one or more of the following tests:

    • Throat culture. In this procedure, the back of your throat is swabbed with sterile cotton and the tissue sample cultured on a special medium to help determine which bacteria or fungi, if any, are causing your symptoms.
    • Endoscopic examination. In this procedure, your doctor examines your esophagus, stomach and the upper part of your small intestine (duodenum) using a lighted, flexible tube with a camera on the tip (endoscope). The test, called an esophagogastroduodenoscopy, takes between 30 and 60 minutes. You’ll be given a sedative to make you more comfortable and a local anesthetic so that you don’t cough or gag when the endoscope is inserted. There’s a slight risk of perforation of your esophagus, stomach or duodenum and of an adverse reaction to medication you may be given.
    • Barium swallow. In this test, you’ll need to drink one or two barium “milkshakes” — glasses of thick, chalky liquid that may be flavored so that they go down more easily. X-rays are then taken as the barium flows through your esophagus into your stomach.


    Oral thrush is seldom a problem for healthy children and adults, although the infection may come back even after it’s been treated. For people with compromised immune systems, however, thrush can be more serious.

    Children with HIV may have especially severe symptoms in their mouth or esophagus, which can make eating painful and difficult. As a result, they don’t receive adequate nutrition, just when they need it most. In addition, thrush is more likely to spread to other parts of the body in people with cancer, HIV or other conditions that weaken the immune system. In that case, the areas most likely to be affected include the digestive tract, lungs, liver and skin.


    The goal of any treatment is to stop the rapid spread of the fungus, but the best approach may depend on your age and the cause of the infection.

    Treating oral thrush in children
    Toddlers with mild oral thrush who are otherwise healthy may need no  treatment at all. If the infection develops after a course of antibiotics, your doctor may suggest adding unsweetened yogurt to your child’s diet to help restore the natural balance of bacteria. Infants or older children with persistent thrush may need an antifungal medication.

    Treating oral thrush in infants and nursing mothers
    If you’re breast-feeding an infant who has oral thrush, you and your baby will do best if you’re both treated. Otherwise, you’re likely to pass the infection back and forth. Your doctor may prescribe a mild antifungal medication for your baby and an antifungal cream for your breasts. If your baby uses a pacifier or feeds from a bottle, wash and rinse nipples and pacifiers every day until the thrush clears up.

    Treating oral thrush in healthy adults
    If you’re a healthy adult with oral thrush, you may be able to control the infection by eating unsweetened yogurt or taking acidophilus capsules or liquid. Acidophilus is available in natural food stores and many drugstores. Some brands need to be refrigerated to maintain their potency. Yogurt and acidophilus don’t destroy the fungus, but they can help restore the normal bacterial flora in your body. If this isn’t effective, your doctor may prescribe an antifungal medication.

    Treating oral thrush in adults with weakened immune systems
    Most often, your doctor will recommend an antifungal medication, which may come in one of several forms, including lozenges, tablets or a liquid that you swish in your mouth and then swallow.

    The normal course of treatment is usually 10 to 14 days. Unfortunately, Candida albicans can become resistant to antifungal medications, especially in people with late-stage HIV infection. A drug known as amphotericin B may be used when other medications aren’t effective.

    Some antifungal medications may cause liver damage. For this reason, your doctor will likely perform blood tests to monitor your liver function, especially if you require prolonged treatment or have a history of liver disease


    The following measures may help reduce your risk of developing Candida infections:

    • Try using yogurt or acidophilus capsules when you take antibiotics.
    • Treat any vaginal yeast infections that develop during pregnancy as soon as possible.
    • If you smoke, ask your doctor about the best ways to quit.
    • See your dentist regularly — at least every six to 12 months — especially if you have diabetes or wear dentures. Brush and floss your teeth as often as your dentist recommends.
    • Try limiting the amount of sugar and yeast-containing foods you eat, including bread, beer and wine. These may encourage the growth of Candida.


    These suggestions may help during an outbreak of oral thrush:

    • Practice good oral hygiene. Many dentists recommend brushing at least twice a day and flossing at least once. If you have problems with strength or dexterity in your hands, an electric toothbrush can make brushing easier. Avoid mouthwash or sprays — they can destroy the normal flora in your mouth.
    • Try warm saltwater rinses. Dissolve 1/2 teaspoon of salt in 1 cup of warm water. Or rinse with a mild baking soda solution — 1 teaspoon of soda in 1 cup of warm water. Swish the rinses, but don’t swallow.
    • Use nursing pads. If you’re breast-feeding and develop a fungal infection, this will help prevent the fungus from spreading to your clothes. Look for pads that don’t have a plastic barrier, which can encourage the growth of Candida. For more information on breast-feeding, you can contact the La Leche League at (847) 519-7730. Or check its Web site.

    Mayo Clinic

    Athlete’s foot (tinea pedis)

    Filed under: Uncategorized — Tags: , , , , , , — patoconnor @ 1:22 pm

    Athlete’s foot (tinea pedis)

    What causes it?

    © NetDoctor/Geir Tight-fitting trainers are a common cause of athlete’s foot. Athlete’s foot is a fungal infection of the foot caused by parasites on the skin called dermatophytes. Dermatophytes can be divided into three groups according to their favourite hosts:

    • fungi preferring soil (geophile)
    • fungi preferring animals (zoophile)
    • and fungi preferring humans (anthropophile).

    Athlete’s foot is usually caused by anthropophile fungi. The most common species are Microsporum, Epidermophyton and Trichophyton. These account for 90 per cent of all skin fungal infections, commonly referred to as ringworm.

    The medical terms for athlete’s foot are tinea pedis or dermatophytosis palmaris, plantaris and interdigitalis – the latter indicates that, in addition to the soles and toes of the feet, the palms of the hands can also become infected.

    What causes it?

    We all have one or more of the fungi that can cause athlete’s foot on our bodies. They feed on dead skin cells and are usually harmless.

    Athlete’s foot is a common condition in young people and adults. The fungi love warm, moist places with the result they are primarily a problem for people who wear tight-fitting trainers or don’t dry their feet properly.

    The condition is contagious. It can be spread by direct skin-to-skin contact and indirectly through towels, shoes, floors, etc.

    What are the symptoms?

    There are two variants of the condition.

    Classic cases

    The infection is caused by one of the most common fungi.

      • A red itchy rash in the spaces between the toes (often between the 4th and 5th toes initially) and possibly small pustules.
      • Often a small degree of scaling.
      • The infection can spread to the rest of the foot and other parts of the body.
      • The skin reddens and its furrows become marked, resembling chalked lines.

      • If the condition is not treated, a similar rash may appear on one or both palms.

      • After a while, the rash becomes scaly, resembling eczema.
    • Rarer cases

      Infection of the soles of both feet by Trichophyton rubrum.

    Who is at increased risk?

    • Young people, especially if they wear trainers.
    • Athletes.
    • People who are forced to wear tight-fitting rubber footwear because of their job.

    What can be done at home?

    • Wash the feet every day and allow them to dry properly before putting on shoes and socks. You should use a separate towel to dry your feet. To avoid passing the infection on you should not share these towels with anyone else.
    • Wear socks made of cotton or wool, and change them at least twice a day or when they have become damp.
    • Avoid wearing shoes which are made of synthetic materials. Wear sandals or leather shoes instead.
    • Powder the feet and the inside of the shoes with an antifungal powder.

    How is it diagnosed?

    • The diagnosis can usually be made on the basis of the appearance of the foot.
    • The doctor may take a scrape for microscopy and culture.

    Future prospects

    • The condition can sometimes disappear simply through being exposed to fresh air, but medical treatment is usually required.
    • An infection of the foot may be accompanied by an infection of the nails.

    How is athlete’s foot treated?

    • Athlete’s foot can be treated locally with antifungal creams, sprays, liquids and powders that are available from pharmacists without a prescription. Imidazole antifungals are most effective and include clotrimazole (eg Canesten AF) and miconazole (eg Daktarin). Other antifungals include zinc undecenoate (Mycota), terbinafine (Lamisil AT) and tolnaftate (Mycil).
    • Treatment should be continued for two weeks after the symptoms have disappeared to ensure the infection has been treated effectively.
    • Some antifungal creams also contain hydrocortisone, eg Daktacort HC. These are useful when the skin is particularly red and inflamed, as the hydrocortisone reduces inflammation and irritation. They should not be used for longer than seven days. They are not suitable for children under 10 or during pregnancy and breastfeeding, unless prescribed by a doctor. After seven days, treatment should be continued with a plain antifungal.
    • If the athlete’s foot has not started to respond after two weeks’ antifungal treatment you should see your doctor, who may prescribe a stronger antifungal cream or antifungal tablets.

    Based on a text by Dr Flemming Andersen and Dr Ulla Søderberg, consultant dermatologist

    Last updated 01.04.2005


    ………Athlete’s Feet

    Don’t let the name fool you. Athletes aren’t the only ones who get the itchy condition known as athlete’s foot. Anyone can get athlete’s foot if two things happen:

    • Their bare feet are exposed to a kind of fungus.
    • That fungus has the right environment to grow – like hot and sweaty sneakers! 

    A Fungus Is a Microorganism
    Athlete’s foot, or tinea pedis (say: tin-ee-uh peh-dus), is a common
    skin infection that is caused by a fungus (say: fun-gus), a plant-like microorganism (say: my-kro-or-guh-niz-um) too small to be seen by the naked eye. This fungus eats old skin cells. And plenty of them can be found on the feet!

    Although athlete’s foot occurs mostly among teen and young adult guys, kids and women can get it, too. People with sweaty or damp feet are at risk. Walking barefoot where others also walk barefoot is one way the fungus can get on your feet in the first place. That’s why your mom or dad might say to wear your sandals when you’re showering in a public shower.

    Why Is It Called Athlete’s Foot?

    Athlete’s foot gets its name because athletes often get it. Why? The fungus that causes it can be found where athletes often are. The fungus grows on the warm, damp surfaces around pools, public showers, and locker rooms. People walk barefoot on these surfaces and fungus ends up on their feet. Or they might use a damp towel that has the athlete’s foot fungus on it.

    But just having the fungus on your feet isn’t enough to cause the infection. The infection happens if conditions are right for the fungus to grow. The fungus likes it wet, so:

    • Dry your feet properly after swimming, showering, or bathing.
    • Do not wear tight shoes when your feet are sweaty.
    • Do not wear the same pair of shoes or socks day after day.

    What Are the Signs and Symptoms?
    Cases of athlete’s foot can be mild to severe. A person who has it may have a rash that itches and burns. Other signs and symptoms include:

    • bumps on the feet
    • cracked, blistered, or peeling areas, often between the toes
    • redness and scaling on the soles of the feet
    • skin between the toes may look “cheesy” and have an unpleasant odor
    • a rash that spreads to the instep (inside part of the foot)
    • raw skin from scratching (try not to scratch!)

    Athlete’s foot may spread to other parts of your foot, including your toenails. It can also infect other parts of the body – such as the groin (commonly called jock itch) and underarms – but only if someone scratches the infection and touches these places.

    What Will the Doctor Do?
    A doctor such as a dermatologist (say: dur-muh-tal-uh-jist), a skin doctor, or podiatrist (say: puh-dye-uh-trist), a foot doctor, can figure out if you have athlete’s foot. It could be something other than athlete’s foot, too. Kids can get other foot conditions or might be allergic to a material in the shoes they’re wearing.

    But a doctor will be able to tell by looking at the skin on your feet. Your doctor may swab or scrape off a skin sample to test for fungus or for bacteria. Don’t worry, this won’t hurt – you have lots of extra layers of skin on your feet! 

    Treatment is usually simple. For mild cases, your doctor may have you apply a powder that contains medicine or cream that kills fungus, which should make your feet feel better in a few days. Sometimes you’ll need to use the medicine for up to a month to get rid of the athlete’s foot completely.

    You’ll also need to keep your feet dry and keep your shoes off as much as possible because fungus can’t easily grow in dry, open air. If doing these things doesn’t help clear up the infection, your doctor may then prescribe a stronger medicine. This one will be the kind you swallow, not just something that you apply to your feet. 

    It’s important to see a doctor about your athlete’s foot because if it goes untreated, it will continue to spread, making your feet feel really itchy and uncomfortable and will become harder to get rid of. Also, more serious infections can also develop on your feet.

    Athlete’s Foot Prevention
    Many people will develop athlete’s foot at least once in their lives. Some will get it more often. To help avoid it:

    • Wash your feet every day.
    • Dry your feet thoroughly, especially between the toes.
    • Sometimes go barefoot at home – especially at night.
    • Avoid wearing tight or synthetic footwear that doesn’t allow your feet to “breathe.”
    • Wear sandals around pool areas, public showers, and gyms to steer clear of the fungus.
    • Wear socks that soak up wetness. Cotton is one material that does this.
    • Change your socks every day (or more frequently) if they get damp.
    • Ask your parent to buy antifungal powder to put in your sneakers or shoes.
    • Spray your shoes with a disinfectant and set them in out in the sun to help kill germs.
    • Don’t share towels or footwear.
    • Keep home bathroom surfaces clean – especially showers and tubs.

    Reviewed by: Patrice Hyde, MD
    Date reviewed: December 2004

    Kids Health


    Filed under: fungal infections — Tags: , , , , , , — patoconnor @ 1:19 pm



    Ringworm is a contagious fungus infection that can affect the scalp, the body, the feet (athlete’s foot), or the nails.

    • People can get Ringworm from: 1) direct skin-to-skin contact with an infected person or pet, 2) indirect contact with an object or surface that an infected person or pet has touched, or 3) rarely, by contact with soil.
    • Ringworm can be treated with fungus-killing medicine.
    • To prevent Ringworm, 1) make sure all infected persons and pets get appropriate treatment, 2) avoid contact with infected persons and pets, 3) do not share personal items, and 4) keep common-use areas clean

    Ringworm is a contagious fungus infection that can affect the scalp, the body (particularly the groin), the feet, and the nails. Despite its name, it has nothing to do with worms. The name comes from the characteristic red ring that can appear on an infected person’s skin. Ringworm is also called Tinea.

    What is the infectious agent that causes Ringworm?

    Ringworm is caused by several different fungus organisms that all belong to a group called “Dermatophytes.Different Dermatophytes affect different parts of the body and cause the various types of Ringworm:

    • Ringworm of the scalp
    • Ringworm of the body
    • Ringworm of the foot (athlete’s foot)
    • Ringworm of the nails

    Where is Ringworm found?

    Ringworm is widespread around the world and in the United States. The fungus that causes scalp Ringworm lives in humans and animals. The fungus that causes Ringworm of the body lives in humans, animals, and soil. The fungi that cause Ringworm of the foot and Ringworm of the nails live only in humans.


    How do people get Ringworm?

    Ringworm is spread by either direct or indirect contact. People can get Ringworm by direct skin-to-skin contact with an infected person or pet. People can also get Ringworm indirectly by contact with objects or surfaces that an infected person or pet has touched, such as hats, combs, brushes, bed linens, stuffed animals, telephones, gym mats, and shower stalls. In rare cases Ringworm can be spread by contact with soil.


    What are the signs and symptoms of Ringworm?

    Ringworm of the scalp usually begins as a small pimple that becomes larger, leaving scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Yellowish crusty areas sometimes develop.


    Ringworm of the body shows up as a flat,round patch anywhere on the skin except for the scalp and feet. The groin is a common area of infection (groin Ringworm). As the rash gradually expands, its center clears to produce a ring. More than one patch might appear, and the patches can overlap. The area is sometimes itchy.


    Ringworm of the foot is also called athlete’s foot. It appears as a scaling or cracking of the skin, especially between the toes.


    Ringworm of the nails causes the affected nails to become thicker, discolored, and brittle, or to become chalky and disintegrate.


    How soon after exposure do symptoms appear?

    Scalp Ringworm usually appears 10 to 14 days after contact, and Ringworm of the skin 4 to 10 days after contact. The time between exposure and symptoms isnot known for the other types of Ringworm.


    How is Ringworm diagnosed?

    A health-care provider can diagnose Ringworm by examining the site of infection with special tests.


    Who is at risk for Ringworm?

    Anyone can get Ringworm. Scalp Ringworm often strikes young children; outbreaks have been recognized in schools, day-care centers, and infant nurseries. School athletes are at risk for scalp Ringworm, Ringworm of the body, and foot Ringworm; there have been outbreaks among high school wrestling teams. Children with young pets are at increased risk for Ringworm of the body.


    What is the treatment for Ringworm?

    Ringwormcan be treated with fungus-killing medicine. The medicine can be in taken in tablet or liquid form by mouth or as a cream applied directly to the affected area.


    What complications can result from Ringworm?

    Lack of or inadequate treatment can result in an infection that will not clear up.


    Is Ringworm an emerging infection?

    Although Ringworm is not tracked by health authorities, infections appear to be increasing steadily, especially among pre-school and school-age children. Early recognition and treatment are needed to slow the spread of infection and to prevent re-infection.


    How can Ringworm be prevented?

    Ringworm is difficult to prevent. The fungus is very common, and it is contagious even before symptoms appear.

    Steps to prevent infection include the following:

    • Educate the public, especially parents, about the risk of Ringworm from infected persons and pets.
    • Keep common-use areas clean, especially in schools, day-care centers, gyms, and locker rooms. Disinfect sleeping mats and gym mats after each use.
    • Do not share clothing, towels, hair brushes,or other personal items.

    Infected persons should follow these steps to keep the infection from spreading:

    • Complete treatment as instructed, even after symptoms disappear.
    • Do not share towels, hats, clothing, or other personal items with others.
    • Minimize close contact with others until treated.
    • Make sure the person or animal that was the source of infection gets treated.

    This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above or think that you might have a fungus infection, consult a health-care provider.

    Health Promotion Foundation



    Alternative names    Return to top

    Dermatophytid; Tinea

    Definition    Return to top

    Ringworm is a skin infection caused by a fungus. Ringworm can affect skin on your body (tinea corporis), scalp (tinea capitis), groin area (tinea cruris, also called jock itch), or feet (tinea pedis, also called athlete’s foot). 

    Often, there are several patches of ringworm on your skin at once. 

    Causes, incidence, and risk factors    Return to top

    Ringworm is a common skin disorder, especially among children, but it may affect people of all ages. Although its name suggests otherwise, it is caused by a fungus, not a worm. 

    Many bacteria and fungi live on your body. Some of these are useful to you and your body. Others can multiply rapidly and form infections. Ringworm occurs when a particular type of fungus grows and multiplies anywhere on your skin, scalp, or nails. 

    Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact or by contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces. You can also catch ringworm from pets that carry the fungus. Cats are common carriers. 

    The fungi that cause ringworm thrive in warm, moist areas. Ringworm is more likely when you have frequent wetness (such as from sweating) and minor injuries to your skin, scalp, or nails. 

    Symptoms    Return to top

  • The symptoms of ringworm include: 
  • Itchy, red, raised, scaly patches that may blister and ooze. The patches often have sharply-defined edges. They are often redder around the outside with normal skin tone in the center. This may create the appearance of a ring. Your skin may also appear unusually dark or light.
  • When your scalp or beard is infected, you will have bald patches.
  • If nails are infected, they become discolored, thick, and even crumble.  
  • Signs and tests    Return to top

    Your doctor will diagnose ringworm primarily based on the appearance of the skin. If tests are needed, the fungus may appear florescent when your skin is examined with a blue light (called a Wood’s lamp) in a dark room. A more definitive diagnosis can be made by scraping the affected area of skin and examining the cells under a microscope. 

    Treatment    Return to top

  • Ringworm usually responds well to self-care within 4 weeks without having to see a doctor. 

  • Keep your skin clean and dry.
  • Apply over-the-counter antifungal or drying powders, lotions, or creams. Those that contain miconazole, clotrimazole, or similar ingredients are often effective.
  • Wash sheets and nightclothes every day while infected. A severe or persistent infection may require treatment by a doctor. Antifungal pills may be given and are necessary if your hair is infected. Prescription antifungal skin medications, such as ketoconazole, are stronger than over-the-counter products and may be needed. Antibiotics may also be needed to treat related bacterial infections. 

    Infected pets also should be treated. 

  • Expectations (prognosis)    Return to top

    Skin medication is usually successful at treating Ringworm within 4 weeks. If your ringworm infection is severe or resistant (meaning that it does not respond well to self-care), it will usually respond quickly to antifungal pills. 

    Complications    Return to top

  • Spread of ringworm to other areas
  • Bacterial skin infections
  • Contact dermatitis or other skin disorders
  • Side effects from medications
  • Calling your health care provider    Return to top

  • Call your doctor right away if you have any signs of a bacterial infection, which can result from scratching. These signs include swelling, warmth to the touch, sudden worsening in redness of the patches, red streaking, pus, discharge, and fever. 

    Call your doctor if: 

  • Ringworm infects your scalp or beard.
  • Your skin does not improve after 4 weeks of self-care.
  • Prevention    Return to top

  • <P xmlns:ax=””&gt;To prevent ringworm: 

    <UL xmlns:ax=””&gt;

  • Keep your skin and feet clean and dry.
  • Shampoo regularly, especially after haircuts.
  • Do not share clothing, towels, hairbrushes, combs, headgear, or other personal care items. Such items should be thoroughly cleaned and dried after use.
  • Wear sandals or shoes at gyms, lockers, and pools.
  • Avoid touching pets with bald spots.
  • References    Return to top

    Weinstein A. Topical treatment of common superficial tinea infections. Am Fam Physician. 2002; 65(10): 2095-2102. 

    Gupta AK. Treatments of tinea pedis. Dermatol Clin. 2003; 21(3): 431-462. 

    Pratte M. Common skin conditions in athletes. Clin Fam Pract. 2003; 5(3): 653. 


    Update Date: 6/16/2005

    Medline Plus

    Tinea Infections

    Filed under: fungal infections — Tags: , , , — patoconnor @ 1:13 pm

    Tinea Infections

    If your kids are active, chances are that locker-room showers and heaps of sweaty clothing are part of their everyday lives. It’s important to take the proper precautions so that your child doesn’t develop fungal skin infections that can be itchy and uncomfortable.

    Jock itch, athlete’s foot, and ringworm are all types of fungal skin infections known collectively as tinea. They are caused by fungi called dermatophytes that live on skin, hair, and nails and thrive in warm, moist areas.

    Symptoms of these infections can vary depending on where they are on the body. The source of the fungus is usually the soil, an animal (usually a cat, dog, or rodent), or most often, another person. Minor trauma to the skin (for instance, scratches) and poor skin hygiene increase the potential for infection.

    It’s important to learn some of the signs and symptoms of these infections so that you can get the proper treatment for your child. Many of these infections can be treated with over-the-counter medication, but some of them may require treatment from your child’s doctor.

    Ringworm isn’t a worm, but a fungal infection of the scalp or skin that got its name from the ring or series of rings that it can produce. Ringworm may first appear on your child as a red, scaly patch or bump on the skin that becomes very itchy. It may cause your child to experience dandruff-like scaling and hair loss (with broken stubbles of hair).

    Symptoms of Ringworm
    Ringworm of the scalp may start as a small sore that resembles a pimple before becoming patchy, flaky, or scaly. These flakes may be confused with dandruff. It may cause some hair to fall out or break into stubbles. It can also cause the scalp to become swollen, tender, and red.

    Sometimes, there may be a swollen, inflamed mass known as a kerion, which oozes fluid. These symptoms can be confused with impetigo or cellulitis. The distinctive features of ringworm are itching, redness on the skin, and a circular patchy lesion that spreads along its borders and clears at the center.

    Ringworm of the nails may affect one or more nails on your child’s hands or feet. The nails may become thick, white or yellowish, and brittle.

    If you suspect that your child has ringworm, you may want to call your child’s doctor.

    Treating Ringworm
    Ringworm is fairly easy to diagnose and treat. Most of the time, the doctor can diagnose it by looking at it or by scraping off a small sample of the flaky infected skin to test for the fungus. The doctor may recommend an antifungal ointment for ringworm of the skin or an oral medication for ringworm of the scalp and nails.

    Preventing Ringworm
    A child usually gets ringworm from another infected person, so it’s important to encourage your child to avoid sharing combs, brushes, pillows, and hats with others. 

    Jock Itch
    Jock itch, an infection of the groin and upper thighs, got its name because cases are commonly seen in active kids who sweat a lot while playing sports. But the fungus that causes the jock itch infection can thrive on the skin of any kids who spend time in hot and humid weather, wear tight clothing like bathing suits that cause friction, share towels and clothing, and don’t completely dry off their skin. It can last for weeks or months if it goes untreated.

    Symptoms of Jock Itch
    The symptoms of jock itch may include:

    • itching, chafing, or burning in the groin, thigh, or anal area
    • skin redness in the groin, thigh, or anal area
    • flaking, peeling, or cracking skin

    Treating Jock Itch
    Jock itch can usually be treated with over-the-counter antifungal creams and sprays. If you are using one of these substances, make sure that your child takes the following steps so that the treatment is as effective as possible:

    • Wash and then dry the area using a clean towel.
    • Apply the antifungal cream, powder, or spray as directed on the label.
    • Change clothing, especially the underwear, every day.
    • Continue this treatment for 2 weeks, even if symptoms disappear, to prevent the infection from recurring.

    If the ointment or spray is not effective, you may want to call your child’s doctor, who can prescribe other treatment.

    Preventing Jock Itch
    Jock itch can be prevented by keeping the groin area clean and dry, particularly after showering, swimming, and performing sweaty activities.

    Athlete’s Foot
    Athlete’s foot typically affects the soles of the feet, the areas between the toes, and sometimes the toenails. It can also spread to the palms of the hands, the groin, or the underarms if your child touches the affected foot and then touches another body part. The condition got its name because it affects people whose feet tend to be damp and sweaty, which is often the case with athletes.

    Symptoms of Athlete’s Foot
    The symptoms of athlete’s foot may include itching, burning, redness, and stinging on the soles of the feet. The skin may flake, peel, blister, or crack.

    Treating Athlete’s Foot
    A doctor can often diagnose athlete’s foot simply by examining your child’s foot or by taking a small scraping of the affected skin to detect the presence of the fungus that causes athlete’s foot.

    Over-the-counter antifungal creams and sprays may effectively treat mild cases of athlete’s foot within a few weeks. Athlete’s foot can recur or be more serious. If that’s the case, you may want to call your child’s doctor who may prescribe a stronger treatment.

    Preventing Athlete’s Foot
    Because the fungus that causes athlete’s foot thrives in warm, moist areas, infections can be prevented by keeping your child’s feet and the space between the toes clean and dry.

    Athlete’s foot is contagious and can be spread in damp areas, such as public showers or pool areas, so you may want take some extra precautions with the feet. You may want to encourage your child to:

    • wear waterproof shoes or flip-flops in public showers, like those in locker rooms
    • alternate shoes or sneakers to prevent moisture buildup and fungus growth
    • avoid socks that trap moisture or make the feet sweat and instead choose cotton or wool socks or socks made of fabric that wicks away the moisture
    • choose sneakers that are well ventilated with small holes to keep the feet dry

    By taking the proper precautions and teaching them to your child, you can prevent these uncomfortable skin infections from putting a crimp in your active child’s lifestyle.

    Reviewed by: Patrice Hyde, MD
    Date reviewed: May 2005



    Tinea Infections

    “Tinea” refers to a skin infection with a dermatophyte (ringworm) fungus.

    Depending on which part of the body is affected, it is given a specific name.

    Sometimes, the name gives a different meaning.

    • Tinea versicolor, also more accurately called Pityriasis versicolor, a common yeast infection on the trunk
    • Tinea incognito when the clinical appearance has changed because of inappropriate treatment
    • Tinea nigra affects the palms orsoles which appear brown (on white skin) or black (on dark skin)

    DermNet NZ

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