FUNGAL INFECTIONS

The skin may be infected by yeasts or fungi and the clinical presentation varies with organism, body site infected and the body’s response to the infection. Most infections are due to anthropomorphic species that infect humans primarily. Yeasts such as Candida spp (intertrigo, thrush) and Pityrosporum spp (tinea/pityriasis vesicolor, folliculitis) are common.

Dermatophyte (tinea) infections are common and do not necessarily imply underlying systemic disease.

Deep fungal infections (mycetomas, sporotrichosis, blastomycosis) occur rarely. Systemic fungal infections (histoplasmosis, cryptococcosis) are increasingly seen in immunocompromised patients and need systemic therapy.

GENERAL MEASURES

Manage predisposing factors, i.e. occlusion, maceration and underlying conditions such as diabetes, eczema, immunocompromise, etc. Advise patient regarding spread of infection and exposure in communal, shared facilities (dermatophytes).

MEDICINE TREATMENT

Candida

Imidazole, e.g.:

• Clotrimazole 1%, topical, apply 8 hourly until clear of disease.

Pityrosporum

Selenium sulphide 2.5% suspension, applied once weekly to all affected areas. o Allow to dry and leave overnight before rinsing off.

• Repeat for 3 weeks.

Dermatophytes 

Imidazole, e.g.:

• Clotrimazole 1%, topical, apply 8 hourly until clear of disease.

Systemic antifungal therapy

Topical treatment is generally ineffective for hair and nail infections.

Recurrent infections are not uncommon if repeat exposure is not prevented.

• Fluconazole, oral, 200 mg daily for two weeks.
  • In tinea capitis, 200 mg daily for 4 weeks.

REFERRAL

»     Non-repsonsive infections.

»     Systemicinfections.