Medicines Used for Fungal skin infections

Symptoms of fungal skin infections

The usual sign is an itchy, scaly or flaky rash, and its look depends on where it is and on skin colour: it tends to look red on light skin and grey, brown or purple on brown or black skin. Ringworm usually shows up 4 to 14 days after contact with the fungus. Signs include:

• On the body: an itchy, ring-shaped patch with a slightly raised, scaly edge and a clearer centre; rings can grow, overlap or appear as several patches
• Athlete's foot: itchy, white, peeling or cracked skin between the toes, most often the smallest ones, which may bleed; it can spread to the sole and heel and sometimes forms fluid-filled blisters
• Jock itch: an itchy, scaly, red or darker rash on the inner folds of the upper thighs and groin
• On the scalp: a scaly, itchy, round patch with hair loss, which can grow and spread to new patches; it is most common in children
• In the nails: thick, brittle or crumbly nails that turn white or yellow and may lift off, usually toenails
• Pityriasis versicolor: flat, round patches on the chest, upper back, upper arms, neck or tummy that are pink, red or pale brown on light skin and paler than the skin around them on brown or black skin; they may be scaly or itchy and do not tan
• Thrush in skin folds, such as the armpits or groin: a red, itchy or painful rash that may scale over

What causes fungal skin infections?

Two main groups of fungi cause skin infections. Ringworm fungi infect the skin, hair and nails and spread from person to person through skin contact, from pets and other animals, from shared towels, combs, bedding, socks and shoes, from damp floors in showers and changing rooms, and less often from soil. Yeasts are different: they normally live harmlessly on the skin and cause pityriasis versicolor, skin-fold thrush and possibly dandruff when they grow more than usual. Pityriasis versicolor and dandruff do not spread from person to person and are not caused by poor washing. Infections take hold more easily on skin that stays warm, damp and sweaty, or that is already cracked or damaged.

Who is more likely to get fungal skin infections?

• Sweating a lot, or skin that stays damp, for example from tight shoes, socks or synthetic clothes
• Walking barefoot in shared showers, changing rooms or pool areas
• Contact sports such as wrestling
• Living or in close contact with someone who has ringworm, or with a pet or other animal that has patches of missing fur
• Diabetes
• A weakened immune system, for example from chemotherapy, an organ transplant or long-term steroids
• Using steroid creams on a rash that turns out to be ringworm, which can make it worse and help it spread

When to get emergency help

When to see a doctor

• A rash that has not improved after a few weeks of pharmacy treatment, keeps coming back or is very painful
• Ringworm on the scalp, or nails that look infected, because these usually need prescription tablets and testing
• A foot or leg that becomes hot, red or darker, swollen and painful, even without fever: get an urgent appointment the same day, as this may be cellulitis
• A rash that is widespread, unusually inflamed, spreading to the hands or face, or started after contact with someone who has a severe infection
• Diabetes or a weakened immune system with any fungal skin infection, especially on the feet
• Patches of skin that change colour, since vitiligo and psoriasis can look similar

How fungal skin infections is diagnosed

A doctor or pharmacist often recognises a fungal skin infection by how it looks, but psoriasis, vitiligo and other conditions can look alike, so testing helps when the picture is unclear or treatment has not worked. The common test is a KOH test: a little skin is scraped from the rash, mixed with potassium hydroxide, which dissolves skin cells, and checked under a microscope for fungus. A fungal culture grows the fungus from skin scrapings or nail clippings to show which type it is, and results can take days or weeks. Nails are usually tested before treatment, and liver blood tests may be done before and during antifungal tablets. Some hard-to-treat ringworm fungi are misidentified by standard culture and need specialist laboratory tests.

How fungal skin infections is treated

Fungal skin infections are treated with antifungal medicines, which damage the fungus's outer layer or stop it making part of it, so it cannot grow. Ringworm of the body, athlete's foot and jock itch are usually treated with creams, sprays or powders; common types are the azole antifungals, such as clotrimazole, miconazole and ketoconazole, and terbinafine. These are generally used for 2 to 4 weeks and continued after the rash clears, because stopping early can let it return. Scalp ringworm does not respond to creams and needs prescription tablets, such as terbinafine, itraconazole, fluconazole or griseofulvin, often with a medicated shampoo, for one to three months. Nail infections need months of tablets or a medicated nail paint. Pityriasis versicolor is treated with an antifungal shampoo such as ketoconazole applied to the skin, a cream or, if widespread, tablets; skin colour can take months to return. Antifungal tablets need a doctor's supervision: itraconazole, for example, interacts with many medicines and can worsen heart failure. Steroid creams, alone or mixed with an antifungal, can make ringworm worse, spread it and hide it, so guidelines in India and abroad advise against using them on ringworm or any undiagnosed rash. The choice depends on the site, extent, age, pregnancy and other medicines, and is made with a doctor or pharmacist.

Medicines used for fungal skin infections

These active ingredients are in medicines whose approved uses include Fungal skin infections. Brands are listed A to Z, not ranked. A doctor or pharmacist decides which medicine is right for you.

Clotrimazole

• Candid Cream · 1% skin cream

Itraconazole

• Itrasys 100 · 100 mg capsule

Ketoconazole

• Nizral 2% · 2% medicated shampoo

Preventing fungal skin infections and day-to-day care

Keeping skin clean and dry is the main defence: dry well after bathing, especially between the toes and in skin folds, and change socks and underwear every day. Wear loose cotton clothes, avoid shoes that make feet sweaty, and use flip-flops in shared showers. Do not share towels, combs, clothes, shoes or sports gear, wash towels and bedsheets often, and wash your hands after handling animals or soil. Avoid scratching, which can spread the rash. If someone at home has ringworm, Indian dermatologists advise treating everyone affected at the same time, and a pet with patches of missing fur should see a vet. Children with ringworm can usually go to school once treatment has started. Treating athlete's foot early helps stop it spreading to the nails and lowers the chance of cracked skin letting in bacteria.

Possible complications

• Spread to other parts of the body, such as from the feet to the hands or toenails, where it is slow to treat
• Cellulitis, a bacterial skin infection that can enter through cracked skin from athlete's foot, more likely in people with diabetes
• Widespread, hard-to-treat ringworm, made more likely by steroid creams, including forms that resist some antifungal medicines

Fungal skin infections in India

Indian dermatologists report that ringworm of the body, groin and face has become more common, longer-lasting, recurrent and harder to treat in India over recent years. Indian experts link this partly to creams that combine a steroid with an antifungal, often with an antibiotic, which are sold over the counter, and a 2020 consensus from the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) strongly discouraged steroid creams, alone or combined, for ringworm. A fungus linked to this rise, Trichophyton indotineae, often does not respond to terbinafine and has now been reported across Asia and in Europe, Canada and the United States.

Common questions