Tinea Versicolor

Tinea Versicolor

Tinea versicolor (pityriasis versicolor) is a fungal infection of the topmost layer of the skin causing scaly, discolored patches.

The infection, caused by the yeast Malassezia furfur, is quite common, especially in young adults. It rarely causes pain or itching, but it prevents areas of the skin from tanning, producing patches that are lighter in color than surrounding skin. People with naturally dark skin may notice lighter patches; people with naturally fair skin may get dark or lighter patches. The color depends on how the yeast affect the melanocytes, the cells that make the pigment . The patches are often on the chest or back and may scale slightly. Over time, small areas can join to form large patches.

Diagnosis and Treatment

Doctors can diagnose tinea versicolor by its appearance. A doctor may use an ultraviolet light to show the infection more clearly or may examine scrapings from the infected area under a microscope to confirm the diagnosis.

Topical antifungal cream such as ketoconazole (NIZORAL) may be used, as well as terbinafine (LAMISIL AT) solution spray. Prescription selenium sulfide (SELSUN) shampoo is effective if applied full-strength to the affected areas (including the scalp) at bedtime, left on overnight, and washed off in the morning. Treatment is usually continued for 3 or 4 nights. Alternatively, the shampoo can be applied for 10 minutes a day for 10 days. Prescription ketoconazole (NIZORAL) shampoo is also effective; it is applied and washed off in 5 minutes. It is used as a single application or daily for 3 days.

Antifungal drugs taken by mouth, such as itraconazole (SPORANOX), ketoconazole (NIZORA),  or fluconazole (DIFLUCAN), are sometimes used to treat widespread, resistant infection However, because these drugs may cause unwanted side effects, topical drugs are usually preferred.

The skin may not regain its normal pigmentation for many months after the infection is gone. Tinea versicolor commonly comes back after successful treatment because the fungus that causes it normally lives on the skin. Therefore, many doctors recommend use of 2.5% selenium sulfide (SELSUN) shampoo or ketoconazole (NIZORAL) shampoo monthly or every other month to prevent recurrences.

Merck

Tinea Versicolor


What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the skin. Patches are most often found on the chest or back and prevent the skin from tanning evenly. It occurs mostly in adolescence and early adulthood, but it can occur at any time.
What are the symptoms of tinea versicolor?

Usually, the only symptom of tinea versicolor is the white or light brown patches. Patches may scale slightly, but rarely itch or hurt. Other common characteristics of the rash include the following:

• white, pink, or brown patches
  
• infection only on the top layers of the skin
  
• the rash usually occurs on the trunk
  
• the rash does not usually occur on the face   

  patches worsen in the heat, humidity, or if you are on steroid therapy or has a weakened immune system
  

• patches are most noticeable in the summer

The symptoms of tinea versicolor may resemble other skin conditions. Always consult your physician for a diagnosis.
<How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination. The patches seen with this condition are unique, and usually allow the diagnosis to be made on physical examination. In addition, your physician may use an ultraviolet light to see the patches more clearly. Also, your physician may do skin scrapings of the lesions to help confirm the diagnosis.
Treatment for tinea versicolor:

Specific treatment for tinea versicolor will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment usually includes the use of dandruff shampoo on the skin, as prescribed by your physician. The shampoo is left on the skin overnight and washed off in the morning. To be effective, the shampoo treatment may be required for several nights. Tinea versicolor usually recurs, requiring additional treatments. Your physician may also prescribe topical creams or oral antifungal medications. It is also important to know that improvement in the skin may only be temporary, and a recurrence of the condition is possible. Your physician may also recommend using the shampoo monthly to help prevent recurrences. The treatment will not bring the normal color back to the skin immediately. This will occur naturally and may take several months.

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

Blastomycosis

Blastomycosis

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.

CDC 

 

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Blastomycosis

 

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 BSome Trade Names
FUNGIZONE
or oral itraconazoleSome Trade Names
SPORANOX
. 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.

Merck

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

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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.

References

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.

 

Article

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) candidiasis — Candida 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.

Symptoms

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.

Esophagitis — Candida 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.

Prevention

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

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.

Prognosis

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
Email: nidcrinfo@mail.nih.gov

Last updated August 20, 2005

Intelihealth  

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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.

FDA

Oral Thrush

Overview

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 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  

Causes

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.

Complications

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.

Treatment

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

Prevention

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.

Self-care

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)

Athlete’s foot (tinea pedis)

What causes it?

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

NetDoctor

………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

Ringworm

RINGWORM

 

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

……….

Ringworm

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=”http://www.adam.com”&gt;To prevent ringworm: 

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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

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