Dermatomycosis: an overview of skin mycoses

By Cristiano Antonino On Jun 1, 2023

Cutaneous mycoses (or dermatomycosis) are infections of the skin and skin adnexa caused by pathogenic fungi (mycetes); they generally present as characteristic lesions in the affected area, of varying extent and severity; they are diagnosable by the dermatologist and, in most cases, easily treatable

In some cases, such as in fragile or immunocompromised patients (transplanted patients or those undergoing chemotherapy treatment) mycoses can however become systemic and cause serious clinical pictures.

What are cutaneous mycoses?

Under physiological conditions, skin fungi are part of the normal skin flora and are harmless; in fact, they behave as saprophytes, living with our organism without damaging it.

In certain situations, however, such as in cases of intense stress, excessive exposure to the sun or altered immune defences, they can turn into opportunists, proliferate and cause real pathology.

Generally, skin mycoses are superficial and caused by dermatophytes or yeasts

Systemic mycoses, i.e. mycoses that attack organs, are the most dangerous forms and can be caused by moulds; among these, some can be contracted by inhalation and cause, for example, lung infections.

Mycoses are also called opportunistic when they affect individuals with compromised immune systems.

Fungi can be divided into three main groups

dermatophytes, which infect the stratum corneum of the epidermis (the superficial layer of the skin) and keratinised skin attachments such as hair, hair and nails, as they feed on keratin itself. Dermatophytes are generally responsible for the appearance of rosette-like spots on the trunk (tinea corporis), feet (tinea pedis) and groin folds (tinea cruris);
yeasts, which reproduce very quickly and develop in warm-humid body areas such as armpits, submammary folds, ano-genital region. In these cases one observes the appearance of pinkish-white scales sometimes associated with oedema. Itching is extremely common;
moulds, which are the most dangerous, as they can affect internal organs and are only rarely associated with skin signs and symptoms.

Mycosis, the risk factors

Mycosis of the skin occurs in the presence of certain predisposing factors:

heat
humidity
excessive use of detergents
poor personal hygiene
diabetes
obesity
poor diet
stress
excessive sweating
habitual wearing of poorly breathable clothing
pregnancy (due to hormonal changes)
use of immunosuppressive drugs
tumours
prolonged treatment with cortisone or antibiotics, as they can alter the body’s immune defences by transforming fungi normally present on the skin into pathogenic microorganisms
frequenting crowded places with bare feet, such as swimming pools and beaches

Symptoms of skin mycoses

Symptoms clearly vary from individual to individual, thus depending on their general condition and comorbidities, but also depending on the severity and extent of the mycosis and the pathogen responsible.

Very often, skin mycoses cause white or reddish patches on the skin, usually with a slightly raised and peeling edge.

Sometimes they are associated with the appearance of blisters or boils, skin discolourations, thickening or thinning of the nails, and – in cases of scalp involvement – alopecia.

Patients may have no symptoms or complain of itching.

The following are some types of cutaneous mycosis.

Tinea pedis (or athlete’s foot)

Called athlete’s foot because it mostly affects sportspeople, tinea pedis is very common among those who frequent the hot and humid environments of swimming pools and gyms.

It is a highly contagious disease, which is caught by contact: sufferers lose small fragments of skin that scatter in the environment, settling on objects and surfaces that are then used by teammates and locker room attendants (showers, floors, footpads, etc.).

Sufferers of tinea pedis initially notice the appearance of an infection between the third and fourth toes or between the fourth and fifth toes, which can then spread to the sole, back and nails.

Typical symptoms of athlete’s foot are:

erythema
itching
reddened skin
peeling of the skin between the toes and on the sole of the foot
thickening of the skin
watery blisters
thick, unnaturally coloured nails with a tendency to tear
malodorous feet

Onychomycosis

An infection of the nails, onychomycosis can affect the feet as well as the hands.

It mainly affects those who frequent humid environments, but is favoured by conditions such as poor personal hygiene and wearing shoes that are too tight.

Onychomycosis usually manifests itself with a white or yellow spot in one corner of the nail (rarely it is the entire nail surface that becomes all white) associated with

deformation and brittleness of the nail
opaque and raised lamina
inflammation of the tissues surrounding the nail
bad smell
nail lifting and detaching

Pityriasis versicolor

A benign disease, pityriasis versicolor affects the skin surface and causes alterations in the normal pigmentation of the skin, resulting in the appearance of small spots on the trunk -generally the upper part- that are lighter or darker than the surrounding skin.

It is not contagious and is most common in infants, children and adolescents.

Cutaneous candidiasis

Cutaneous candidiasis affects individuals of all ages in the presence of certain risk factors: heat, poor personal hygiene, tight clothing, infrequent nappy changes, altered flora, immunosuppression.

The typical symptom is the appearance of itchy, erythematous spots, which are associated with

whitish maceration with anal itching (perianal candidiasis)
vaginal itching and discharge (candidal vulvovaginitis)
white or yellowish nails with damaged edges and lamina (candida nail infections)
white and sometimes bleeding plaques on the oral mucosa (oropharyngeal candidiasis)
fissures and small cuts on the lips

How to diagnose a cutaneous mycosis

If a skin mycosis is suspected, it is strongly recommended to contact the treating doctor, who can then recommend a specialist dermatological consultation.

Having a typical appearance, skin mycoses are in most cases diagnosed through a simple objective test.

In other, doubtful cases, the specialist may deem it necessary to perform a swab or collect a small portion of tissue for microscopic study or a culture test.

The Wood’s Lamp is a special lamp that, through the emission of UV radiation, makes it possible to highlight fungal infections.

How to treat skin mycosis

The treatment of cutaneous mycosis depends on the pathogen responsible and the type of infection and is based on the use of drugs.

The dermatologist can prescribe topical antifungals such as sprays, creams, lotions, mousses, nail polishes, powders and cleansers, or drugs to be taken orally, especially when mycosis proves difficult to eradicate.

The most commonly used drugs to treat skin fungus are

clotrimazole, used mainly for cutaneous candidiasis, pityriasis versicolor, ringworm and athlete’s foot.
miconazole, to be applied locally
ketoconazole, to be applied as a cream
terbinafine, topically or orally
griseofulvin, an antifungal in tablet form used when other drugs are ineffective

How can cutaneous mycoses be prevented?

The prevention of cutaneous mycosis is based on the adoption of certain behavioural norms.

First of all, proper personal hygiene is recommended, using non-aggressive cleansers; drying the skin well and avoiding walking barefoot in crowded, hot and humid places such as swimming pools and changing rooms.

In gyms, it is important to use a personal towel before lying on benches or mats

Clothing, from underwear to clothes, should be made of natural fibres and not be too tight.

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