Fungus

Fungal infections of the skin are common. Athletes foot (weepy, scaly skin in the toe spaces) is probably the commonest but a similar condition can affect any hot, sweaty area of the skin such as the groins. Sometimes fungal infections can spread to other areas of the body.

On the scalp fungal infection can lead to thick crusting and eventually a patch of permanent baldness.

(click on image to enlarge)

Fungal infection of the nails causes yellow crumbly thickening of the nails. Fungal infection of the skin causes scaly patches to appear which can radiate outwards leaving normal skin in the centre to give a round ring of scale and this leads to the name "ringworm". Fungal infections are treated with anti-fungal creams or anti-fungal tablets depending upon the appearance.

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Scabies

Scabies is a very common skin infection which leads to itch and finally leads to eczema. Fairly close physical contact between people is required for transmission. There is often a history of a close personal contact having had an itchy rash as well. The condition affects both children and adults. The spaces between the fingers are commonly affected. The genital area in males is a common site and around the nipples in females is another common site. However, most patients have a widespread itchy rash and detecting individual sites of involvement amongst the rash can be extremely difficult. There are various available treatments for scabies. It is important for the treatment to be applied to all of the skin from the neck downwards (not just picking out the itchy sites). It is also important for close contacts to be treated on the same day. The treatment should be left on the skin for twenty-four hours and all bedding and clothing should be washed and changed. I advise my own patients to repeat this treatment again after one week (even though one good treatment is often completely successful). The second treatment is a precaution. It is very important to understand that even after successful treatment (where the infection has been killed off) the resulting eczema does not fade away for at least six weeks. It is important that repeated scabies' treatments are not given during this time because they can make the eczema worse. Moisturizers and weak steroids should help the eczema to fade away but these should not be used until at least 24 hours after the scabies treatment applications.

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Warts - click on image to enlarge

The commonest type of wart is a viral wart. These are the common warts which are typically passed between children at school. They are caused by invisible viruses infecting the outer layer of the skin. The commonest sites are the fingers and feet (where they are called verrucas) but any body site can be affected. Warts are less common in adults but can be very troublesome in adults who have reduced immunity for any reason, Patients with a tendency to eczema also have an increased predisposition to warts. Treatments include - skin surface wart paints, freezing the skin with medical spray guns of various types and laser burning. Surface paints are relatively painless and work so long as they are applied regularly (at least 4 times per week). Before each new application, the dead skin from the previous paint application must be thoroughly removed by builders abrasive sand paper or pumice stone. Sometimes treatment takes several months to be fully effective. Freezing treatment (cryotherapy or liquid nitrogen therapy) is very commonly used by dermatologists and is highly effective. However, it is a bit painful and causes blistering and scabbing lasting about 1 week after treatment. At least 4 treatments are usually needed for common warts and sometimes many more for large or multiple warts. For all these reasons (especially the pain at the time of treatment), young children are not usually able to tolerate this cryotherapy and frequently end up using simple wart paints.

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Molluscum

These are another type of wart caused by a slightly different virus. They are not hard and scaley like common warts, they are soft and fleshy. They typically measure only about 0.3cm and usually affect not the fingers and feet, but soft skin. Young children under 5 years are most commonly affected. Common areas of involvement are around the thighs and buttocks, the trunk, or under the armpits. Sometimes many dozens appear quite rapidly. A parent should gently massage these until the cheesey central contents are extruded and then apply a single drop of antiseptic paint onto the skin surface - this will often make them go away. This should be done when the child is calm or even asleep and should be performed very gently - this process should not be painful. Sometimes cryotherapy or other medical advice is needed. Children with a tendency to eczema have an increased predisposition to molluscum.

This is a common condition which is thought to be due to a viral infection. Patients develop a widespread , slightly scaly rash which can look like either eczema or psoriasis. The clue to this condition is the fact that it tends to appear initially as just one or two inflamed patches somewhere on the skin which lasts for about two weeks before the rest of the skin becomes involved with the rash. The body is involved more often than the arms and legs. Usually this condition is self-limiting and gradually fades away over the period of about 2-3 months. Simple moisturisers or weak topical steroids are sometimes helpful if the condition is itchy.