Fungus Among Us: Common Fungal Infections
Saturday, September 10, 2011
By Karla Robinson, MD
For some, the summertime generally means more time in the gym and outdoor activities like basketball, flag football, and golf.  But enjoying the warm weather can also lead to an increased risk of sweat related fungal infections. Sweating is a normal physiologic process whereby the body is able to cool itself when overheating.  However when excessive sweating occurs as is the case in rigorous physical activity, fungal infections can easily develop.
Athlete’s Foot (tinea pedis) is one of the most common fungal infections reported by men.  It is contagious and is often spread from person to person in the settings of locker rooms, swimming pools, and communal showers where it is common to be barefoot.  It may present in an acute form often following an episode of excessive foot sweating, or in a chronic form which can persist and progress if left untreated.
Acute athlete’s foot is often very itchy and occasionally presents with painful red blisters on the feet or between the toes.  Chronic athlete’s foot usually presents as scaly skin on the bottom of the feet and toes or it can appear as cuts or fissures between the toes.  Both acute and chronic forms can usually be treated with a course of topical antifungal cream for one to four weeks.  For more resistant or extensive cases involving the nail, oral treatment may be required.
Fungal nail infection (onychomycosis) can also be seen in conjunction with athlete’s foot.  While the effect of fungus in the nail is primarily limited to unwanted changes in the appearance of the nail, in severe cases it may cause pain or discomfort as the nail becomes deformed or destroyed.  As the fungus grows, the affected nail will typically become discolored turning either a yellow, white or brown color.  As the infection progresses, the nail can them become very thickened or deformed. Diagnosing nail fungus is relatively quick and easy.  It simply involves testing nail scrapings or clippings and can be done in the office.   
Once the diagnosis is confirmed, treatment is usually oral medication as topical creams and liquids are ineffective in treating this condition.  Typically the treatment is an extended process with the therapy often extending 6-12 months before any improvement or resolution can be seen.  In those that are unable to tolerate oral therapy, some studies have shown that other common home remedies may be effective.   A daily application of over-the-counter medicated chest rub or eucalyptus and menthol containing antiseptic mouthwash to the affected nail may help to resolve the infection.
Jock itch (tinea cruris) is a fungal infection often beginning on the inner thigh and spreading to involve the groin and occasionally the buttock region.  It is usually seen in someone that has an untreated athlete’s foot or fungal nail infection and is the result of rigorous physical activity that leads to excessive amounts of sweat.  It has also been seen in outbreaks among athletes when towels and infected equipment have been shared.  
It is always important to get checked and treated for athlete’s foot or nail fungus if jock itch is ever diagnosed to prevent potential recurrence of the condition.  Treatment is usually in the form of a topical cream with resolution in one to four weeks.  Keeping the thigh and groin area dry with garments such as loose fitting clothing, boxer shorts, or other moisture-wicking attire is often helpful in preventing the condition.
Tinea versicolor is an extremely common, non-contagious fungal infection of the skin most often found on the chest, back, and arms.  It can often present as light or dark spots on the skin that can appear slightly scaly.  Some may find the lesions itchy, while others may not have any symptoms other than the skin changes.  The diagnosis can be made easily by a physician, with topical therapy resolving the spots in two to three weeks.  For resistant or very widespread infections, it is sometimes necessary to use oral medication for treatment. For those with recurrent infections, it can sometimes be helpful to use over-the-counter selenium sulfide or prescription antifungal shampoo as body soap once a month to keep infections at bay.
Fungus will always thrive in warm, dark, and moist environments.  To prevent these fungal skin infections, try to shower as soon as possible and dry the skin completely when experiencing excessive sweat.
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Urban Legends:
Fungal Infections
1.  A fungal infection is a sign of poor hygiene. This is false.  Fungi naturally live on human skin.  When the conditions are moist, warm, and dark, it can cause an overgrowth of fungus and lead to an infection.  It is not caused by dirt, or lack of cleanliness.   
2.  It is not possible for me to have athlete’s foot if my feet are not itchy. This is a common myth and is false!  Acute athlete’s foot infections are typically itchy, whereas chronic athlete’s foot can simply present with cracked, scaly, or fissured skin.  Whether you consume alcohol daily or not, the risk of binge drinking, alcohol dependence, and alcoholism still exists.
3.  Fungal nail infections are often times serious.  This is not true.  Often times, fungal infections of the nail are purely a cosmetic concern.  Occasionally in those who have other medical conditions, or in whom the destruction of the nail is severe, it may lead to bacterial infections requiring prompt treatment. 
4.  Fungal infections of the nail can be treated by over-the-counter antifungal creams.  Fungal nail infections are not easily treated by topical medications and typically require prescription oral medication.  However, some over-the-counter treatments such as antiseptic soaks, and menthol containing chest rub creams have proven to treat the infection.  Talk with your doctor about a treatment that is appropriate for you. 
This was printed in the September 11, 2011 - September 24, 2011 Edition.

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