Establishing a diagnosis before starting treatment is essential in the management of fungal skin infections. This can be achieved by having a high index of suspicion regarding the many clinical appearances of fungal infections and by using simple diagnostic tests. The three most common fungal conditions include tinea, pityriasis versicolor and candidiasis; however, this article will mention some rarer conditions including tinea nigra and piedra.
- Cutaneous fungal infections present in a large variety of ways, many of which mimic noninfectious conditions. Establishing a diagnosis is essential before starting treatment, especially if oral antifungal therapy is considered.
- If the diagnosis is uncertain, avoid using corticosteroid treatment, which can obscure the fungal infection resulting in tinea incognito.
- Topical antifungal treatment is adequate in most fungal infections; however, for infections of the palms, soles, nails, hairy body areas, tinea incognito, granulomatous lesions and in widespread infection, oral treatment is usually required.
- Referral to a dermatologist is recommended in cases of treatment resistance.
- Investigate for underlying immune deficiency if the infection is widespread or recurrent.