Fungal rashes in children are very common. A fungal rash is a skin manifestation of a fungal infection that can be found in different areas on the skin and scalp. One of the most common fungal rashes we see is a candidal diaper rash. Dr. Bornstein discusses the symptoms, causes and treatment for the different fungal rashes your child may be diagnosed with.
SYMPTOMS:
Red, crusted, oozing regions of the skin or scalp
CAUSES:
Fungi, including Candida, Malassezia furfur, Trichophyton, Microsporum, and Epidermophyton
DIAGNOSIS:
The observance of symptoms usually makes it diagnosable. The color and position of the rash on the body are very indicative. A fungal rash sometimes is diagnosed by shining a Wood’s lamp (black light) on the rash and finding fluorescence (if it is Microsporum). Also, a scraping of the skin can be taken and tested. The scraping can be placed in agar to look for color changes over a week.
Fungal spores can be seen under a microscope. Doctors can take cultures to test for fungi, but it can take weeks for the results.
TREATMENT:
· Antifungal creams, ointments, shampoos
· Oral antifungal medicines
The most common creams and ointments are nystatin (Nystatin, Micostatin, Mytrex, Pedi-dri), miconazole (Lotrimin, Desenex, Monistat, Fungoid), clotrimazole (Lotrimin, Mycelex-7, Clotrimazole), econazole (Spactazole), ketoconazole (Nizoral), oxiconazole (Oxistat), tolnaftate (Tolnaftate), or terbinafine (Lamisil).
The most common oral medicines are fluconazole (Diflucan), griseofulvin (Fulvicin, Grifulvin, Gris-Peg, Grisactin), itraconazole (Sporanox), ketoconazole (Nizoral) and oral terbinafine (Lamisil).
A selsun-containing shampoo (Selsun, Head, and Shoulders) or a ketoconazole shampoo (Nizoral) can be helpful for the fungus of the head.
Treatment should continue until the rash resolves.
CONTAGION:
Fungal rashes are contagious until they have been treated for at least 24 hours. Fungal rashes of the scalp must be treated for weeks before contagion completely resolves; however, transmission is so minimal that children should not be kept out of school once treatment has started. The fungus can be transmitted from person to person or from pet to person. The incubation period is days to weeks.
DISCUSSION:
There are many different types of fungi causing many kinds of rashes. The most common type is candidal diaper rash, seen in infants. This kind of rash is usually a very red rash that gets into the creases of the skin with surrounding red spots called satellite lesions. It commonly occurs in the diaper area due to this dark, wet environment that allows the fungus to grow. A fungal cream or ointment and leaving the area open to air help resolve this rash. Infants frequently get oral thrush that is candida in the mouth. This can also be treated with antifungal drops like nystatin (Nystatin, Micostatin, Mytrex, Pedi-dri), or oral antifungals like fluconazole (Diflucan).
Tinea versicolor is a fungal rash of the skin caused by Malassezia furfur. This rash usually consists of red scaly spots that eventually leave white patches that do not tan. This can be treated with topical antifungals.
Tinea capitis is a fungal head rash caused by Trichophyton or Microsporum. Microsporum will fluoresce under a Wood’s lamp making diagnosis easier. Usually, an oral medication such as griseofulvin (Fulvicin, Grifulvin, Gris-Peg, Grisactin) is given for at least six weeks to treat this infection.
Tinea corporis is a fungal rash on the body caused by Trichophyton or Microsporum.
Tinea corporis/Ringworm which most people know this rash as ringworm since it appears as a round red ring with a normal center. A topical antifungal will usually work. Tinea cruris is a fungal rash of the groin, commonly known as jock itch. An epidermophyton species cause it. Itching is typically severe, and treatment is with a topical antifungal.
Tinea pedis is a fungal rash of the foot commonly known as Athlete’s foot. Trichophyton or epidermophyton causes it. It can be very itchy. A topical antifungal is used for this rash.
Tinea ungum is a fungal infection of the nails caused by trichophyton. Usually, long-term oral therapy with itraconazole (Sporanox) is needed to treat this rash. All fungal rashes are contagious until they are gone, although transmission is unlikely once treatment begins.
ONE DOCTOR’S OPINION:
There are so many fungal rashes with so many different presentations. I have some general rules of thumb for treating these rashes:
· If it’s on the head or in the nails, you need oral medicine.
· If it is on the body, any antifungals mentioned above can be used.
· If I see a rash and I’m sure it’s fungal, I treat it. If I see a rash and I’m unsure of the cause, I think eczema first, fungal second, and scabies third since these rashes are similar and very common. I’ll try treatment for each of these in succession. If the rash doesn’t resolve, I recommend seeing a dermatologist for help.
Written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
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