Everything You Need to Know About Fungal Skin Infections

Fungi live everywhere. They can be found in soil, in the air, or even inside the body. They can also be found on plants, surfaces, or the skin. These microscopic organisms typically don’t cause any problems for your skin unless they multiply faster than normal or penetrate the skin through a cut or lesion.

Since fungi thrive in warm, moist environments, fungal skin infections can often develop in sweaty or damp areas that don’t get much airflow. Some examples include the feet, groin, and folds of the skin.

These infections usually appear as a scaly rash or as discolored and often itchy skin.

You often acquire a fungal skin infection through direct contact. This can include coming into contact with fungi in or on:

• another person
• an animal
• items such as clothing
• gyms
• gym mats, like those used in wrestling
• hot tubs
• saunas and steam rooms

Some fungal skin infections are very common. Although the infection can be uncomfortable and possibly contagious, it’s typically not serious unless you’re immunocompromised.

Did you know?

Although there are millions of species of fungi, just a few hundred of them can actually cause infections in humans, according to the Centers for Disease Control and Prevention (CDC).

What’s more, only a few of those species are dermatophytes, which can affect the skin, nails, and hair. Nondermatophyte fungi can affect the nails but are more likely to occur in other places, such as the lungs or brain.

Many common fungal infections can affect the skin.

Yeast infection (Candida skin infection)

Yeast is a type of fungus.

A yeast called Candida is naturally present on the skin and inside the human body. When it overgrows, an infection can occur, including on the skin. The most common species of Candida is Candida albicans.

Other names for a yeast infection of the skin include:

• a Candida skin infection
• a candidal skin infection
• cutaneous candidiasis
• candidiasis of the skin

The infection occurs in warm, moist, and poorly ventilated areas. Areas that are typically infected include the folds of the buttocks (as in certain types of diaper rash) and under the breasts.

The symptoms of a yeast infection of the skin can include:

• a red or discolored rash
• itching
• stinging
• burning
• acne-like bumps around the rash

Other yeast infections

The mucous membranes are another common site of fungal infections. Some examples of yeast infections in the mucous membranes are vaginal yeast infections and oral thrush.

How it’s diagnosed

A primary care doctor should be able to diagnose a yeast infection of the skin during a physical examination. They may also swab the skin and use a skin culture to confirm that yeast is the organism causing your symptoms.

If you see a dermatologist instead, they may perform a skin scraping of the rash and then view the sample under a microscope to determine if there’s Candida growth.

How it’s treated

An important step in treating any yeast infection is keeping the skin clean and dry.

Some yeast infections will go away on their own. Prescription and over-the-counter (OTC) antifungal drugs are also available. These drugs can either kill fungi directly or prevent them from growing and thriving.

Topical versions include:

• clotrimazole
• econazole
• ketoconazole
• nystatin
• oxiconazole

To help reduce itching, you can also use a corticosteroid cream such as hydrocortisone.

Powders may help you keep your skin dry. It’s important to apply them 2 to 3 hours before or after applying any creams.

If the infection doesn’t resolve or improve, a doctor may prescribe oral antifungal medications, such as:

• fluconazole (Diflucan)

To help treat diaper rash, consider using zinc oxide creams to soothe your baby’s skin. OTC options include products from the brands:

• A+D
• Balmex
• Desitin
• Triple Paste

Home remedies such as changing diapers more frequently and using disposable diapers may also relieve symptoms.

Ringworm of the body (tinea corporis)

Ringworm is a common fungal skin infection. It’s highly contagious but not serious.

Despite its name, ringworm is caused by a fungus and not a worm. It typically occurs on the torso and limbs, in a subtype known as ringworm of the body (tinea corporis). Ringworm on other areas of the body can go by different names, such as jock itch and athlete’s foot.

The main symptom of ringworm is a ring-shaped rash with slightly raised edges. The skin inside these circular rashes usually looks healthy. The rash can spread and is often itchy.

Ringworm can come from petting an animal infected with the fungus or from gyms and gym mats.

How it’s diagnosed

A doctor can usually diagnose ringworm by sight or after performing a skin scraping.

Some doctors may also perform a fungal culture to help them determine a diagnosis.

How it’s treated

Ringworm of the body that’s limited to a few areas can usually be treated with a topical antifungal medication, such as:

• clotrimazole (Lotrimin AF Ringworm Cream)
• econazole
• ketoconazole (Extina, Ketozole)
• luliconazole (Luzu)
• naftifine
• oxiconazole (Oxistat)
• sulconazole (Exelderm)
• terbinafine (Lamisil AT Cream, Silka Antifungal Cream)

Doctors often recommend oral antifungals for a deeper or more extensive infection. They include:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• terbinafine

Ringworm of the scalp (tinea capitis)

This fungal infection affects the skin of the scalp and the associated hair shafts. It’s most common in children and teens 3 to 14 years old.

You can contract ringworm of the scalp from animals, soil, or other humans (via hairbrushes or hats).

Symptoms of ringworm of the scalp (tinea capitis) can include:

• broken hair shafts
• localized bald patches that may appear scaly or red
• associated scaling and itching
• associated tenderness or pain in the patches
• patches that ooze or crust over
• permanent hair loss, in some severe cases

It may resemble severe dandruff.

It can also cause symptoms unrelated to the scalp, such as fever and swollen lymph nodes in the neck.

How it’s diagnosed

A doctor can diagnose ringworm of the scalp during a physical examination.

They usually perform a skin scraping, such as a skin lesion KOH exam. In the skin lesion KOH exam, skin scrapings are mixed with potassium hydrochloride (KOH) to determine if fungi are present.

How it’s treated

Ringworm of the scalp requires prescription oral medication, which may come in the form of a tablet, capsule, or liquid. Examples include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is typically the drug of choice and is safe for children
• itraconazole (Sporanox)
• terbinafine

Everyone with ringworm of the scalp should use an antifungal shampoo. All members of their household should use it too. Examples include ketoconazole shampoo (Nizoral Anti-Dandruff Shampoo).

Jock itch (tinea cruris)

Jock itch happens in the area near your groin and thighs. It’s most common in men and adolescent boys.

The main symptom is an itchy, red, and sometimes painful rash that typically starts in the groin or around the upper inner thighs. The rash may worsen after exercise or other physical activity and can spread to the buttocks and abdomen.

The affected skin may also appear:

• scaly
• flaky
• cracked
• moist and possibly macerated, in the case of an open sore

The outer border of the rash can be slightly raised and darker.

How it’s diagnosed

A doctor can diagnose jock itch during a physical examination or after examining a sample under a microscope.

How it’s treated

Treatment often begins with OTC or prescription creams.

OTC creams, sprays, and powders include:

• butenafine (Lotrimin Ultra Jock Itch Cream)
• clotrimazole (Lotrimin AF Jock Itch Antifungal Cream)
• miconazole (CareALL Miconazole Cream, Lotrimin AF Jock Itch Antifungal Powder Spray)
• terbinafine (Lamisil AT Cream for Jock Itch, Silka Antifungal Cream, Silka Jock Itch Cream)

Prescription creams include:

• econazole
• ketoconazole (Ketozole)
• luliconazole (Luzu)
• oxiconazole (Oxistat)
• sulconazole (Exelderm)

Applying a cool compress can also help soothe the skin.

If topical treatments don’t work, a doctor may prescribe oral antifungals, such as:

• fluconazole (Diflucan)
• itraconazole (Sporanox)
• terbinafine

Oral medications are typically reserved for recurrent, treatment-resistant, or chronic infections.

Tinea versicolor (pityriasis versicolor)

In tinea versicolor, small oval discolored patches develop on the skin. It’s sometimes called pityriasis versicolor.

This infection is caused by an overgrowth of a fungus called Malassezia. Malassezia is naturally present on the skin of most adults.

The discolored skin patches mostly occur on the back, chest, and upper arms, but they can also affect the scalp. They may look lighter or darker than the rest of the skin and can be red, pink, tan, or brown. On people with darker skin, the patches may appear white. These patches can be itchy, flaky, or scaly.

Tinea versicolor is more likely to appear during the summer or in areas with a warm, wet climate. It’s also common in people who work out or sweat often. The condition can sometimes return following treatment.

How it’s diagnosed

A doctor can diagnose tinea versicolor with a:

• physical examination
• Wood’s lamp examination, in which a healthcare professional uses a handheld blacklight to confirm the presence of fungi or bacteria
• skin lesion biopsy, which involves removing a small skin sample and having it tested in a laboratory
• skin lesion KOH exam

How it’s treated

The standard treatment for tinea versicolor is topical products such as soaps, creams, lotions, and shampoos. Ingredients to look for include:

• ketoconazole, found in products such as prescription-strength shampoo and Extina foam
• pyrithione zinc, found in products such as Vanicream Z-Bar Medicated Cleansing Bar, Vanicream Dandruff Shampoo, and Selsun blue Itchy Dry Scalp Antidandruff Shampoo
• selenium sulfide, found in products such as Selsun blue Moisturizing Antidandruff Shampoo and Selsun blue Medicated Antidandruff Shampoo

If tinea versicolor returns following treatment, a doctor may recommend you use a medicated cleanser once or twice a month.

Oral medication is rarely needed. A doctor may prescribe a short course of oral antifungals if tinea versicolor is recurrent, treatment-resistant, widespread, severe, or creates thick scales.

They include:

• fluconazole (Diflucan)
• itraconazole (Sporanox)

Athlete’s foot (tinea pedis)

Athlete’s foot affects the skin on your feet, often between your toes. It can also appear on the soles of your feet.

Typical symptoms of athlete’s foot include:

• itching or a burning, stinging sensation between your toes or on the soles
• skin that appears red, scaly, dry, or flaky
• peeling skin
• thickened soles
• cracked or blistered skin
• deep blisters on the soles, in rare cases

In some cases, the infection can also spread to other areas. Examples include the:

• nails, as in onychomycosis
• groin, as in jock itch (tinea cruris)
• hands, as in tinea manuum

How it’s diagnosed

A doctor can diagnose athlete’s foot by observing your symptoms or performing a skin test such as the skin lesion KOH exam.

How it’s treated

You can treat athlete’s foot with a variety of OTC topical products, such as:

• butenafine (Lotrimin Ultra Athlete’s Foot Cream)
• clotrimazole (CareALL Athlete’s Foot Cream, Lotrimin AF Cream for Athlete’s Foot)
• miconazole (Desenex Athlete’s Foot Shake Powder)
• terbinafine (Lamisil AT Cream, Lamisil AT Cream for Athlete’s Foot, Silka Antifungal Cream)
• tolnaftate (Dr. Scholl’s Odor-X Antifungal Spray Powder, Lotrimin AF Athlete’s Foot Daily Prevention Deodorant Powder Spray, Tinactin Athlete’s Foot Cream)

Terbinafine tends to be the fastest-acting of these medications.

If OTC products don’t help clear up athlete’s foot within 2 weeks or so, a doctor may prescribe:

• prescription-strength topical clotrimazole
• sulconazole (Exelderm)

Doctors usually prescribe oral antifungals when the infection is recurrent, causes blisters, or involves the tops of the feet, soles, or heels. They include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is safe for children
• itraconazole (Sporanox)
• terbinafine

Did you know?

Athlete’s foot tends to recur, so it’s important to dry the toes and feet thoroughly after showering or bathing. Use a powder, especially in between the toes.

Onychomycosis

Onychomycosis is a fungal infection of the nails. It can affect the fingernails or the toenails, although infections of the toenails are 7 to 10 times more common.

Symptoms of onychomycosis include nails that:

• have flaky white patches and pits near the top
• are discolored (typically yellow, brown, black, purplish, green, or white)
• are brittle or break easily
• are thick
• are raised or crusty, in the case of toenails

How it’s diagnosed

A doctor will usually take a nail clipping and some subfungal debris and send them off for a periodic acid–Schiff (PAS) stain or culture.

On some occasions, they may perform a skin lesion KOH exam. However, the PAS stains and cultures are more accurate.

How it’s treated

Prescription medications are often required to treat this type of infection. The standard treatment is oral terbinafine. It’s typically prescribed for 6 or 12 weeks, depending on whether you have a fingernail or toenail infection.

Treatment is notoriously tricky due to factors such as prolonged treatment time and the likelihood of recurrence.

Other oral antifungals that may be used include:

• fluconazole (Diflucan)
• griseofulvin (Fulvicin, Gris-PEG), which is safe for children
• itraconazole (Sporanox)

Doctors often prescribe topical antifungals as well. They include:

• ciclopirox (Ciclodan)
• efinaconazole (Jublia)
• tavaborole (Kerydin)

In severe cases, a doctor may remove some or all of an affected nail.

Emerging treatment options include lasers and light therapy. More data on their effectiveness is needed.

Because a rash is a common symptom of most fungal skin infections, they’re often referred to as fungal skin rashes or fungal rashes. Onychomycosis is one of the few fungal skin infections that doesn’t typically cause a rash.

Several factors can increase your risk of getting a fungal skin infection. They include:

• living in a warm or wet environment
• sweating heavily
• not keeping your skin clean and dry
• sharing items such as clothing, shoes, towels, or bedding
• wearing tight clothing or footwear that doesn’t breathe well
• taking part in activities that involve frequent skin-to-skin contact
• coming into contact with animals that may be infected
• having a weakened immune system due to immunosuppressant drugs, cancer treatment, or conditions such as HIV or AIDS

To help prevent a fungal skin infection from developing, try to keep the following tips in mind:

• Be sure to practice good hygiene.
• Do not share clothing, towels, or other personal items.
• Wear clean clothes every day, particularly socks and underwear.
• Choose clothing and shoes that breathe well. Avoid clothing or shoes that are too tight or have a restrictive fit.
• Make sure to dry off properly with a clean and dry towel after showering, bathing, or swimming.
• Wear sandals or flip-flops in locker rooms instead of walking with bare feet.
• Wipe down shared surfaces, such as gym equipment or mats.
• Stay away from animals that have signs of a fungal infection, such as missing fur or frequent scratching.

Fungal skin infections are common.

Although these infections aren’t usually serious, they can cause discomfort and irritation due to itchy or scaly red skin. If not treated, the rash may spread or become more irritated.

Many fungal skin infections eventually improve in response to OTC fungal treatments. However, call a doctor or other healthcare professional if you:

• have a fungal skin infection that does not improve, gets worse, or returns after OTC treatment
• notice patches of hair loss along with itchiness or scaly skin
• have a weakened immune system and suspect a fungal infection
• have diabetes and think you have athlete’s foot or onychomycosis

If you are immunocompromised or have diabetes, an untreated infection can lead to cellulitis or systemic infection.

Also, call a doctor or other healthcare professional if you have an infection that does not improve with OTC medications. You may need a prescription for more effective treatment.