A practical approach to the diagnosis and treatment of common fungal infections of the skin and hair is provided. Topical antifungal therapies are effective and usually used as first-line therapy, with oral antifungals being saved for recalcitrant infections. Treatment should be for several weeks at least.
- Fungal infection should always be in the differential diagnosis of any scaly rash.
- Topical antifungal agents are typically adequate treatment for simple tinea.
- Oral antifungal therapy may be required for extensive disease, fungal folliculitis and tinea involving the face, hair-bearing areas, palms and soles.
- Tinea should be suspected if there is unilateral hand dermatitis and rash on both feet – ‘one hand and two feet’ involvement.
- Oral antifungal treatments can often be pulsed intermittently, reducing the overall dose required.