Dermatophytosis - Ringworm

Dermatophytosis - Ringworm

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Ringworm is a common and very distressing fungal infection. It is classified sometimes by location and also biologically to describe different organisms which can be cultured. Small red, itching, scaling spots develop on the skin surface, then grow outward. The margin gradually increases in size,while the central portion of the eruption begins to heal spontaneously.Occasionally, after shaving their legs, women can develop deeper fungus infection of the hair follicles, characterized by redness, itching, and granuloma formation.


Another location for infection with the ringworm (Tinea) organism is the nails. Called onychomycosis, this infection usually involves single nails, more commonly on the toes. As fungal organisms grow in the nail plate, the nail becomes opaque, brittle, cracked, and partially separated from its bed. Occa-sionally an associated fungus infection occurs in the surrounding skin.The third type of ringworm, Tinea cruris, occurs in the groin. This may itch and exude some fluid. It slowly spreads until treatment is instituted. The hands, feet, and scalp can also be involved with the Tinea family of organisms. Formerly occurring as an epidemic in children, Tinea capitis is now less common. These round or oval, sharply defined lesions cause breaking of the hair, patchy baldness, and occasionally drain a pus-like material. A special fluorescent (Wood’s) light may illuminate the lesions,producing a bright yellowish-green fluorescence.


The most superficial infection, Tinea versicolor, occurs in hot humid climates. Slight scaling patches usually involve the trunk, neck, and upper arms. Gentle scraping may make the scaling more evident. Confirmation of the diagnosis in these fungus infections involves scraping the scaling lesions into a glass slide.After applying a 10% solution of potassium hydroxide and heating the slide gently, the characteristic fungus organism can be seen under the microscope. They usually appear, like most yeasts and fungi, as branching strands, called hyphae.


Treatment of superficial fungus infections is quite effective, using a number of common antifungal preparations. The application of sulfur ointment, painting with tincture of iodine, or half strength of Whitfield’s  ointment is usually helpful. Topical salicylic acid, or the use of newer creams, such as Tinactin can prove beneficial. Most are over the counter items available at any pharmacy. Toenail involvement is often resistant to therapy. It may require the surgical removal of the nail, or periodic trimming and tolerance of a slow, ever present infection.


Many yeast-type organisms can infect the skin, The most common infection, however, is produced by the yeast Candida albicans. Formerly called monilia, this infection still is described occasionally as Moniliasis. When seen in the mouth, the disease is called thrush. Cottage cheese-like growths are seen along the surface of the cheeks, in the tonsillar area, and coating the tongue surface. Frequent in infancy, this lesion responds well to specific antifungal therapies, such as nystatin, or the painting with Gentian violet.


Vaginal involvement with yeast is also a common occurrence. Often producing inflammation, pain, or a cheesy discharge these Vaginitis infections are easily treated, but seldom completely eradicated. Aggravating factors include the use of hormone agents, birth control pills, and elevated blood sugar, as in uncontrolled diabetes. It is a troublesome affliction of pregnancy, also seen commonly in times of stress, and immune deficiencies.Common hygienic measures, such as the use of cotton undergarments,frequent bathing, and the avoidance of panty hose can allow necessary aeration, to reduce the moist and warm environment that favors growth of Monilia. Douching with one tablespoon of white vinegar in a quart of warm water or the topical application of specific yeast inhibitors may give rapid relief of symptoms and reduce the risk of recurrence.


A third type of yeast infection is seen in babies, occurring again in the moist diaper area. Appearing as pinpoint red papules, then coalescing to a red diaper rash, the yeast grows and spreads. Plastic “disposable” diapers contribute to this predicament. Careful drying, cleansing, and the topical use of mild ointments, such as A & D ointment, Desitin, or a powdered cornstarch can allow improvement of most cases. Ultraviolet light from the sun is helpful, not only in drying involved skin, but killing the offending organism.