Fungal Skin Infections

What are fungal infections?

Skin fungi live in the top layer of skin cells in moist areas of the body, such as between the toes or in the groin and diaper area. Sometimes, the normal balances that keep fungi in check are upset, resulting in an infection.

Some fungal infections cause only a small amount of irritation, while other types penetrate deeper and can cause itching, swelling, blistering, or scaling.

In some cases, fungal infections can cause reactions elsewhere on the body. A child can develop a rash on the finger or hand associated with an infection of the scalp or foot, for instance.

There are many types of fungal skin infections that require clinical care by a physician or other healthcare professional. Those listed below are the most common.

Tinea Infections (Ringworm)

What is ringworm (tinea infection)?

Different fungi, depending on their location on a child's body, cause ringworm. Ringworm is characterized by ring-shaped red, scaly patches with clear centers. The risk of contracting ringworm increases if the child:

  • Is malnourished
  • Has poor hygiene
  • Lives in a warm climate
  • Has contact with other children or pets that have ringworm
  • Is immunocompromised by disease or medication

Did you know?

Ringworm is a misleading term that refers to the circular appearance of the fungal lesion. There are no worms involved.

What are the most common types of ringworm?

The most common types of ringworm include the following:

  • Athlete's foot (tinea pedis or foot ringworm)
    This common condition mostly affects teen and adult males, and is rarely found in children before puberty. Many things can cause athlete’s foot, include sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions. Symptoms of athlete's foot may include:
    • Whitening of the skin between the toes
    • Scaling of the feet
    • Itchy rash on the feet
    • Blisters on the feet
  • Jock itch (tinea cruris or groin ringworm)
    This condition is more common in males and occurs more often during warm weather conditions. It is very rare in females. Symptoms of jock itch may include:
    • Red, ring-like patches in the groin area
    • Itching in the groin area
    • Pain in the groin area
    • Does not usually involve the scrotum
  • Scalp ringworm (tinea capitis)
  • Scalp ringworm is highly contagious, especially among children. It occurs mainly in children between the ages of 2 and 10, but rarely in adults. Symptoms of scalp ringworm may include:

    • Red, scaly rash on the scalp
    • Itching of the scalp
    • Hair loss on the scalp
    • Rash elsewhere on the body

    Ringworm of the scalp can also develop into a kerion, a large, tender lesion over the area of the initial ringworm. This is caused by a hypersensitivity to the ringworm and may be associated with a rash elsewhere on the body and tender lymph nodes in the neck.

  • Nail ringworm (tinea unguium)
    Nail ringworm is an infection of the finger or toenail, characterized by a thickened, deformed nail. This condition is found more often in toenails than fingernails, and is more common in adolescents and adults than young children. Symptoms of nail ringworm may include:
    • Thickening of the ends of the nails
    • Yellow color to the nails
  • Body ringworm (tinea corporis)
    This skin infection is characterized by a ring-like rash on the body or the face. This occurs in all ages and is more common in warmer climates. The symptoms of body ringworm may include:
    • Red, circular lesion with raised edges the middle of the lesion may become less red as the lesion grows
    • Itching of the affected area

Ringworm resembles many skin conditions. Always consult a physician for a diagnosis.

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a medical history and physical examination of the child. The lesions of ringworm are unique, and usually allow for a diagnosis simply on physical examination. The physician may also order a culture or skin scraping of the lesion to confirm the diagnosis.

What is the treatment for ringworm?

Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely, and treatment may need to be repeated. Specific treatment will be determined by the physician based on:

  • The child's age, overall health, and medical history
  • Extent of the condition
  • Location of the ringworm
  • The child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Child or parent’s opinion or preference

Treatment for scalp ringworm (tinea capitis) may include the following:

  • Oral anti-fungal medication - this medication is usually prescribed for four to eight weeks. Some children require longer treatment
  • Use of a special shampoo (to help eliminate the fungus)
  • If a kerion is present (a large, tender, swollen lesion), the physician may order additional medications, such as steroids, to help reduce the swelling
  • Ringworm of the body, groin, and foot is usually treated with a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of the ringworm

Tinea Versicolor

What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the chest or back. This infection, which prevents the skin from tanning evenly, occurs most often in adolescence and early adulthood.

What are the symptoms of tinea versicolor?

Typically the only symptom of tinea versicolor is white or light brown patches. The patches may scale slightly, but they rarely itch or hurt. Other common characteristics of the infection include:

  • White, pink, or brown patches
  • Infection only on the top layers of the skin
  • Rash on the trunk
  • No rash on the face
  • Patches worsen in the heat or humidity
  • Patches worsen if the child is 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 a physician for diagnosis.

How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination of the child. The patches are unique, and usually a diagnosis can be made on physical examination. The physician may also use an ultraviolet light to see the patches more clearly or take skin scrapings of the lesions to confirm the diagnosis.

What is the treatment for tinea versicolor?

Treatment usually includes the use of dandruff shampoo on the skin as prescribed by the physician. The shampoo is left on the skin overnight and washed off in the morning, and may be required for several nights.

Tinea versicolor usually recurs, requiring additional treatments, and sometimes improves temporarily. The physician may prescribe topical creams, oral antifungal medications, or monthly shampoo treatments.

This infection can also cause a change in skin color, which can take several months to return to normal.

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Dermatology

The Division of Dermatology at Children's National Health System continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair, and nails.

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