Topical Antifungals - War of the Worlds

What does fungi and fungus mean and what are they?

Fungi (plural of fungus), together with bacteria, break down the Earth’s organic matter and release carbon, oxygen, nitrogen, and phosphorus into the soil and airⁱ. With the fungi (over 99,000 species strong) being such a player in our planet’s ecology, it is not surprising that they are everywhere in our human lives, from our shower curtains to under our sinks. Fungi like dark, moist areas, so if they’re everywhere—which they are—then they’re certainly between your toes, in your genital area, under your breasts, and—except for plumbers—even between the cheeks of our rear ends.

Obesity increases risk of infection

Obesity raises your risk, due to an increase in the overlap of skin folds, which can break down with irritation, called intertrigoⁱⁱ.

What are the most common fungal infections?

Most of the fungal infections on people are yeasts, like Candida or Malassezia furfur, or dermatophytes. They usually live only in the top layer of your epidermis, and the only definitive diagnostic test is a skin scraping and identification under the microscope or growing it in culture.

What is very weird is that an infection in one part of your body can cause rashes in other parts which are not infections per se, but just the body’s reaction to the infection elsewhere. These are allergic reactions only. Your immune system does a pretty good job at keeping the fungal world out of your world in this War of the Worlds. Yet, different parts of your body have different qualities of immunity, explaining why you may get infections some places and not others (why doesn’t an infection develop when you bite your tongue?).

Candida

In women, although the skin folds of the labia offer the same allure to fungus (dark, moist), deeper into the vagina there’s another conspirator to infection: pH. The vagina is typically acid, with a pH of 4.5 to 5. If you’ve forgotten all of your chemistry, what’s important here is that if fungi don’t like alkaline environments, then they’re going to just love the vagina: it becomes the perfect home for the fungi, most notably Candida. (In fact, determining the pH to be over 7 rules out fungal infection altogether.)

Who are most at risk of fungal infections?

Although the “pretty good job” your immune system does keeping fungus away works for most of us, some people who are immunocompromised (HIV and AIDS patients, those undergoing chemotherapy, etc.) are at particular risk for not only the usual fungi, but the ones considered opportunistic, that is, not usually infectious but ready to invade if the conditions are right. In these individuals, such infections can be life-threatening (occurring in the lung, brain, etc.)

What are the symptoms?

Symptoms depend on what you have and where you have it. The scalp can develop seborrhea/dandruff/etc., causing itching and flaking. The skin can exhibit tinea versicolor (“sun rash”) discolorations. Other tinea variations include tinea capitis (scalp), tinea corporis (over the body), tinea cruris (groin—jock itch), and tinea pedis (foot—athlete’s foot). These can present with itching, mild on the body but intense in the groin and between the toes. Vaginitis from fungus is usually Candida species (Candida albicans) and can make that delicate tissue burn and itch severely.

Therefore, itching, burning, and other sensitivities can occur at any of these sites and be from mild to intense. Scratching can lead to secondary bacterial infections, which will introduce the pain of inflammation and possibly result in abscess formation and the need for an antibiotic to be added to the antifungal.

What to do? Treatment options

Treatments include:

• Time
• Preventing moisture over the susceptible areas
• Medication

Time alone can sometimes see the infection go away if your immune system has the talent for it, but that is unusual, since the fungi gained a foothold (no pun intended) by the habits you maintain, such as perspiration, clothing, etc.

Helpful habits and why talc is not recommended

Sleeping nude to spare the genitals undue perspiration, wearing open-toed shoes, wearing “breathing” fabrics, and generous use of powders (not talc) are the anti-moisture strategies. (The International Agency for Research on Cancer classifies the genital use of talc-based powder as “possibly carcinogenic to humans,” based on the slight increased risk of ovarian cancer in womenⁱⁱⁱ.

Topical preparations otherwise known as medications

Medically, there are numerous topical preparations on the market, some of them prescription only due to their concentrations or risk vs. benefit. Some are better for types of fungal infections than others and some can have side effects (burning, allergic reactions, etc.) the others don’t. Usually skin doctors have developed over the years their favorites for different conditions, but all of the over-the-counter preparations are good starting points. (The only downside to these low-risk medications is that they will render the scraping test used for diagnosis worthless, leaving a health professional relying only on inspection and history for a diagnosis.)

Topical Antifungal  Medication List

Are there alternatives to medications?

Besides moisture control, herbal remedies are popular. Things such as oregano oil and grapefruit seed extract are antifungal. Garlic can be antifungal as well (and pretty good at keeping the vampires away!). Melaleuca (tea tree oil) is used for toenail fungus. Some proprietary formulations combine ingredients.

How long will it take to treat the fungal infection?

Again, this depends on the site. Superficial skin and vagina can be treated very quickily (less than a week), but fungal infections that dig in to tougher-to-penetrate tissues (toe nails, scalp) will take longer, sometimes months.

Fungi in a nutshell

Fungal infections are easy to get, easy to treat (except in the nails), and easy to ignore if the symptoms are mild. They are typically not dangerous. Nail infections are more stubborn and usually require a systemic attack (from the “inside,” using oral medication). Topical remedies are preferred, because oral ones can risk liver damage over the long-term treatment periods necessary for some infections.

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