- Skin and Fungi
- Fungal Rashes
- Risk Factors and Causes for these Rashes
- Symptoms of Fungal Rashes
- Pruritic, Erythematous, Inflamed Rashes
- Dry, Cracked, Blistering Rashes
- Scaly Erythematous Rashes
- Papular Erythematous Rashes
- Flat, Brown, Scaly Rashes
- Diagnosing Fungal Rashes
- Treatment for Fungal Rashes
- Preventing Rashes from Fungi
Skin and Fungi
The human integumentary system is composed of a profound array of microbes, fungi included.
In a recent study done by the National Human Genome Research Institute, DNA sequences revealed a diverse range of fungi, generating around 5 million markers and sequencing about 80 types of fungi in the human skin. 
About 29 million people in the United States are affected by fungal skin infections, and for this very same reason, 3,734 hospital consults were done per year in the United Kingdom. Most of these fungal skin infections are brought about by Candida species and dermatophytes. [1, 2, 3]
Fungi thriving on the skin may be harmless, however, once it multiplies in excess and traverse our natural defenses, fungal skin infections may transpire. Most of these infections present in the human body as rashes, a topic that shall be discussed in this article. [4, 5]
Fungi live in the dead, most superficial layer of the skin, the stratum corneum, in the moist regions of the body. Some fungi may cause no symptoms, while others produce some irritation, as characterized by skin rashes. These rashes usually emerge once the fungi dwell on the protein keratin, which is mostly found in the nails, hair, and, of course, the skin. [6, 7, 8]
Picture 1 : This image exhibits the presence of fungi, along with other microbes, in the superficial layer of the skin.
Risk Factors and Causes for these Rashes
One has a greater risk of acquiring rashes from a fungal infection from the following reasons: [7, 9, 10]
- Long course of corticosteroid therapy
- Recent antibiotic use
- Increased blood glucose , or those with diabetes mellitus
- Previous fungal infections
- Incompetent immune system
- History of cancer
- Human Immunodeficiency Virus
- Warm, damp and humid conditions
- Poor hygienic practices
- Frequent visits to public places like swimming pools and saunas
- Contact with other infected persons
- Infrequent and not thoroughly washed hands
- Damage to skin surface
- Wearing too tight shoes and clothing
Symptoms of Fungal Rashes
In general, they can be pruritic, scaly, erythematous, and with a wide area of extent, but lacking distinct borders. Manifestations of these rashes depend not only on the regions of the involved, but with the fungi types as well. Below are some of the common fungal rashes, in conjunction with their fungal skin illnesses. 
Pruritic, Erythematous, Inflamed Rashes
These rashes are usually red and swollen in appearance, and are associated with dryness, itching, burning, cracking and flaking of the skin. They are frequently found in groin, inguinal, perineal and anal regions. Commonly termed as jock itch, the infection is, more often than not, caused by Tinea cruris. [3,11]
Picture 2 : Jock itch, as characterized by red, dry, flaking rashes in the groin.
Dry, Cracked, Blistering Rashes
Extremely dry skin, with cracked skin peeling from the surface and with pruritic blisters alongside. This type of skin lesions can usually be located on the feet, soles and in between toes. It is usually associated with either itching or stinging. It is brought about by tinea pedis, and is commonly coined as ringworm infection of the foot, or athlete’s foot. 
Picture 3 : Dry, cracked and peeking skin with blisters: all characteristic features of athlete’s foot.
Scaly Erythematous Rashes
Ringworm infection of the body, or tinea corporis, is presented as a ring-like, circular, erythematous skin lesion. These usually begin as a small papule, but eventually progresses into a larger round patch, with scale-like lesions around its borders. These patches are usually itchy, even if they are usually swollen in appearance. They commonly involve the face, and the upper and lower extremities. 
Picture 4 : Circular skin lesions pathognomonic of Tinea corporis.
Papular Erythematous Rashes
Candidal yeast infections are usually related to these kinds of rashes. They are commonly associated with clear oozing fluid, are pruritic or burning, and usually occur in papules and patches. Predominantly located among skin folds, in the groin, anus and beneath a woman’s breasts, these rashes are typical manifestations of diaper dermatitis, vaginal yeast infection, and intertrigo. [12, 13]
Picture 5 : A patient with intertrigo, having erythematous papular skin lesions in the axilla.
Flat, Brown, Scaly Rashes
These rashes are often characterized as non elevated rashes, with hyperpigmentation, and with a scale- like appearance. They are usually noted at the truncal region, and the back, areas most bathed in oil and sebum. These are frequently representations of Tinea versicolor. 
Picture 6 : These are the rashes of Tinea versicolor, non-elevated and hyperpigmented.
Diagnosing Fungal Rashes
- A thorough history taking is of definite importance for diagnosis of these rashes. Included in such histories are diet, prior use of antibiotics, ongoing intake of medications, and personal history of cancer, Acquire Immunodeficiency Syndrome (AIDS), Diabetes Mellitus, and other conditions with immunocompromised states. Aside from which, an ample physical examination may indicate a concrete description of the skin rashes and lesions, allowing for a more straightforward diagnosis of the type of fungal infection. 
- Skin scrapings and samples may also be tested. This is done when oral treatment is considered as management, in extensive skin infections, in conditions refractory to medications, and when the diagnosis is uncertain. In doing so, skin scrapings are derived from the edge of the lesion, with the use of a scalpel. Around 5mm2 of skin scales or flakes are required for an accurate and high yielding culture and microscopic examination. 
- Wood Lamp examination can also be utilized for confirming a fungal etiology on rashes. In this procedure, a black lamp is shined through the specimen. The presence and hue of the fluorescence shall then determine if fungal etiology is of concern. 
Treatment for Fungal Rashes
The management of fungal rashes is mainly based on the type of fungal infection it has been diagnosed with. Most are treatable with antifungal topical medications, which may be gotten over the counter, like 1% terbinafine and 1% clotrimazole, or prescribed, such as 2% ketoconazole and 1% econazole. 
Oral medications are usually utilized if the infection is of large extent, or if the topical medications did not surmise. These drugs are usually counterparts of the topical ones, and are in tablet forms. 
Preventing Rashes from Fungi
Repeated and recurrent fungal skin infections are common, thus fungal rashes can persistently return, especially without effective medical intervention. This is enough reason why the following steps for prophylaxis are important. 
- Wear loose fitted clothing and undergarments
- Avoid sharing other people’s towels or personal garments
- Wear plastic shoes or slippers in communal areas like swimming pools and their changing rooms
- Frequently disinfect bed linens, blankets and pillowcases to eliminate fungal spores
- Good hygienic practices should be employed
- Dry the skin thoroughly after bathing
- Hospital Episodes Statistics, Department of Health, England, 2003-03.
- Merck Manual of Medical Information (2000). Yeast Infections. The Merck Manual of Medical information. Whitehouse Station, New Jersey: Merck & Co, Inc.
- Fungal Skin and Nail Infections: Diagnosis and Laboratory Investigation. Royal College of General Practitioners. 2009 April.