An overview of skin rashes

A skin rash is any area of irritated or swollen skin. Rashes are often itchy, red, painful and dry, and can occur in one area of skin or all over the body. Generally, skin rashes fall into two distinct groups:

• External skin rash: the skin’s  response to external irritation, such as contact dermatitis
• Internal skin rash: the skin’s response to internal irritation, such as oral herpes simplex

The reasons for skin rash are complex and varied, but can be classified into three main groups: bacterial, viral and fungal. Rome wasn’t built in a day, and skin rashes cannot be introduced in one page, but this article will give you a tour of fungal skin infections.

Examples of fungal skin infections

There are many types of fungal skin infections, which may sound intimidating, but you will likely have  heard of one of the following:

• Ringworm: Also known as “tinea”, based on its name, you can probably imagine this condition appears as a ring-shaped or circular rash, which is usually itchy and red. It is a common skin infection caused by a fungus, and can easily be passed to others when touching the infected skin, contaminated clothes, or towels¹
• Athlete’s foot: A common fungal infection that appears on your feet, usually between the toes. The affected skin is often itchy, scaly, sheds white flakes, and may sometimes become dry and cracked. It can spread to your toenails or the sides of your feet without proper treatment. This reference² found on the NHS will give you an overview of this skin disorder
• Candidiasis:³ This is a fungal infection caused by a type of yeast. Yep! Candida is a type of yeast, which in turn is a member of the fungus kingdom. Candida yeast normally lives on the inside of the body or on moist areas of skin, such as the mouth, throat, gut and vagina.  It is usually harmless and you can recover without any treatment, but candidiasis can be itchy and keep coming back

Common symptoms and clinical diagnosis

As mentioned before, there are generally 3 different causes of skin rashes: bacteria, viruses or fungi. We cannot distinguish between these types by the naked eye; the only method to identify and confirm the cause is by a laboratory test. However,  fungal skin rashes have a higher severity, stronger infectiousness, and a higher rate of relapse and reinfection than the other two types. 

Skin rashes may occur on the skin, hair and nails, and often appear itchy and red. At the primary stage, clusters of small blisters and bumps will present on the skin, with fluid in the blisters. When these dry out, the infected area becomes scaly and flaky. 

If you have any symptoms as described, it is always a good idea to consult with your healthcare provider before you put anything on the irritated area. If your healthcare provider suspects it is necessary, you may go for a microscopic examination  (a type of laboratory test) to look for a fungal infection. This can take 2 or 3 weeks to get a diagnosis.

Antifungal medications

The common and effective way to treat fungal skin infections is by using antifungal medications. There are  two types:

Topical antifungals

There are many different types of topical medicine for treating fungal skin infections. They can be creams, ointments, and powders that can be applied directly to the affected areas. Generally speaking, creams are easier for skin to absorb, ointments are better for very dry and thick skin, and powders are good for greasier skin with less moisture. Here are some topical medications typically used for fungal skin infections:

• Clotrimazole⁵
• Econazole
• Terbinafine⁶
• Miconazole

Systemic antifungals

Most fungal skin infections only need external treatment, but it's not always that simple. Fungi can invade your body and break down your body's immune system through damaged skin. In this circumstance, topical medications won’t be sufficient, and stronger tools are needed. Systemic medications are therapies that address the conditions of the entire body. They can be given to the patient by injection, infusion, or oral treatment.⁷ There are 5 main types of systemic antifungals:

• The polyene macrolides, a type of antibiotic, such as amphotericin B, nystatin or pimaricin
• The azoles, for example imidazole, ketoconazole, miconazole, triazole and fluconazole
• The allylamines (e.g., terbinafine)
• Echinocandins (e.g., caspofungin, micafungin)
• Thymidylate synthetases, such as flucytosine

The importance of application and administration

The best way to treat a fungal skin infection is to follow the instructions of your healthcare provider, as each patient is unique. No matter if you are taking topical or oral antifungals, taking insufficient medication or overdosing can make the condition worse. The duration of antifungal treatment varies, it may take anywhere from 3 weeks to 6 months or even longer.⁸ It is important to complete the prescribed course of medication,  get back to your health professional for any follow-up treatment, and be prepared for possible relapse events.

Potential side effects and precautions

Antifungal drugs can cause harmful side effects in a few different ways. Drug-drug interactions between antifungals and antibiotics usually have negative consequences. The medication itself potentially has severe side effects, including:

• Polyene antifungals can lead to chills, headaches, skin rashes, low potassium and sodium, vomiting, rigours and fever
• Azole antifungals can lead to nausea, vomiting, diarrhoea, and abdominal pain
• The allylamines antifungals and echinocandins may cause headaches, rashes, and a fever
• Thymidylate synthetase antifungals commonly cause skin reactions such as rash and urticaria

Finally, each antifungal drug may have its own unique side effects. If you would like more details on specific side effects, the following article⁷ describes more details. Pregnant women or individuals with liver conditions should seek advice from health experts before taking any antifungal or antibiotic drugs. 

When to use combination therapies?

Health professionals may consider using combination therapies to treat patients with invasive infections that are difficult to access otherwise, for those patients who are resistant to multiple drug species, or who have failed to respond to standard treatment.⁹

Lifestyle and hygiene practices

A healthy lifestyle and good hygiene practices are essential to managing and preventing fungal skin rashes. Going to sleep early, drinking adequate water, keeping your room and clothes clean, and getting regular exercise can all really benefit your overall health. Here are some suggestions to help manage and prevent skin rashes:

• Doing laundry: Choose non-irritating detergents and softeners, or soaps to wash your clothes, particularly as hot water cannot kill all bacteria or fungi. If you suspect an infection, separate any clothes that were in contact with the infected skin from other clothes to avoid cross-infections
• Don’t scratch: Your hands and nails carry plenty of invisible bacteria and increase the risk of a second infection. Fungi and bacteria may also spread to other parts of the body through your hands and nails
• Taking a Shower: Give your body a regular clean, but avoid using overheated water. Hot water will open the pores on our skin and let any fungi develop and spread to other areas
• Complementary Diet: A balanced diet can strengthen your immune system. For example, fresh fruit and vegetables are naturally high in  Vitamin C and zinc, which are key to immune function. Some conditions may require reducing foods with high sugar and gluten

If you are interested in knowing more about how self-care and lifestyle changes can improve fungal skin infections, please have a look at this list of conditions by sorting from A to Z on the NHS website.

What should I do if my symptoms don't get better?

If there isn’t any sufficient improvement after your topical treatment, your healthcare professional will arrange an inquiry to evaluate whether you have adequately followed their initial management instructions. They may also consider drug interaction and drug resistance issues. With your agreement, they can arrange a skin sampling test and decide whether you should be given oral treatment instead. The National Institute for Health and Care Excellence (NICE) provides guidance for follow-up appointments and monitoring progress.¹¹

Summary

Many difficult types of fungus cause fungal skin infections, and they can happen anywhere on your body. Infections are usually identified by reddened, itchy and flaky skin, and can very often return as your body’s resistance reduces over time. In general, fungal skin infections occur on the surface of the skin, but can also invade through your skin barrier and develop into a systemic fungal infection. Common topical medications target external symptoms, while systemic medications target the whole of the body and can be given by injection, infusion, or orally. A systemic infection can be difficult to treat, and systemic medications have unavoidable side effects, which can cause more severe problems. As such, the best way to prevent disease development is to closely follow your health professional’s instructions.

Keeping a healthy lifestyle and good personal hygiene can reduce the chances of fungal infections. After all, a strong immune system is the best warrior against fungi and bacteria.