An updated version is available in the linked supplement
Feature Article

Recognising and treating fungal skin infections

Douglas Gin, Lilian Downie



Establishing a diagnosis before beginning treatment is essential to optimum management of fungal skin infections. This can be achieved by recognising the various clinical appearances and using simple diagnostic tests. The primary three conditions are tinea, pityriasis versicolor and candidiasis.

Key Points

  • Establish a diagnosis before beginning treatment. This is especially important if the patient requires oral antifungal medications.
  • Avoid corticosteroid treatment if unsure of the diagnosis as it can mask the diagnosis (tinea incognito).
  • Choose oral therapy for infection in hairy body areas, involvement of the palms, soles and/or nails or for widespread infection; otherwise topical treatment is adequate.
  • Refer when the condition is not improving or getting worse, or there are difficulties with treatment.
  • Look for underlying immune deficiency if there is widespread or recurrent fungal infection.