Superficial fungal infections are benign infections of the skin, scalp and nails caused by Candida albicans or dermatophytes.
Clinical features and treatment
Candidal diaper dermatitis
Erythema of the perianal area with peripheral desquamation and sometimes pustules. Secondary infection may develop.
– Buttocks must be kept clean (ordinary soap and water) and dry.
– Avoid humidity: according to the context, expose the buttocks to air or change diapers more frequently; remove plastic pants.
– Protect the skin with zinc oxide ointment if diarrhoea is present.
– If diaper dermatitis is severe and persistent despite these measures, consider an intestinal infection (nystatin PO: 100 000 IU 4 times daily for 20 days).
– Candidiasis of skin folds: miconazole 2% cream, one application 2 times daily for 2 to 4 weeks
– Oral candidiasis: see Stomatitis, Chapter 3.
– Vulvovaginal candidiasis: see Abnormal vaginal discharge, Chapter 9.
Dermatophytes cause various clinical lesions, depending on the anatomic site involved: scalp, glabrous (hairless) skin, folds or nails.
Common in children. Depending on the species:
Some scalp ringworms are contagious:
• Shave or cut hair short on and around the lesions.
• Local treatment: 2 times daily, clean with soap and water, dry and apply miconazole 2% cream or Whitfield’s ointment for 2 weeks or longer if necessary.
• Administer systemic treatment as local treatment alone does not cure scalp ringworm:
• Suppurative lesions: treat superinfection (see Impetigo) before applying local antifungal treatment.
• For painful kerion: paracetamol PO.
In pregnant lactating/breastfeeding women: oral antifungals are contraindicated. Apply a topical treatment (miconazole 2% cream or Whitfield’s ointment) to limit the spread of infection until it is possible to treat orally.
Erythematous, scaly, pruritic macule with a well-demarcated, raised, vesicular border and central healing.
• For non widespread, localised tinea:
• Reserve oral antifungals for particularly extensive lesions: griseofulvin PO for 4 to 6 weeks or itraconazole for 2 weeks.
• Interdigital spaces (Tinea pedis):
• Groin (Tinea cruris):
Topical treatment as above. If oozing lesions, use miconazole 2% cream only (do not use Whitfield’s ointment).
Dermatophytosis may affect the nails (Tinea unguium, onychomycosis). Treatment is prolonged (12 to 18 months with griseofulvin) thus, in practice, difficult. Failures and relapses are frequent.
|2||In candidal intertrigo, lesions are usually located in the 1st and 2nd interdigital spaces.|