Fungal Infections

Question 1

What are the different types of fungal infections?

Answer 1

Tinea pedis: fungal infection on the feet

Tinea corporis: fungal infection on the arms or legs

Tinea versicolor: fungal infection on the trunk and extremities

Tinea capitis: fungal infection on the scalp, eyebrows, or eyelashes

Tinea cruris: fungal infection on the groin

Question 2

What is tinea corporis?

Answer 2

Definition: fungal infection on the arms or legs aka Ringworm; contagious

S/s:
- Annular lesion with raised peripheral scaling and central clearing (looks like a ring

Tx:
- Topical antifungal cream is required for at least 4 weeks

Note:
- child may return to day care or school once treatment has begun. Identify and treat family members or other contacts.

Question 3

What is tinea capitis?

Answer 3

Definition: fungal infection on the scalp, eyebrows, or eyelashes

S/s:
- Patches of scaling in the scalp with central hair loss
- Risk of kerion development (inflamed, boggy mass that is filled with pustules)

Tx:
- Oral griseofulvin for 4–6 weeks
- Selenium sulfide shampoo may be used to decrease contagiousness (adjunct only)
- No school or day care for 1 week after treatment initiated

Question 4

What is tinea versicolor?

Answer 4

Definition: fungal infection on the trunk and extremities ( circular white patch on skin)

S/s:
- Superficial tan or hypopigmented oval scaly lesions, especially on upper back and chest and proximal arms
- More noticeable in the summer with tanning of unaffected areas

Tx:
- Apply selenium sulfide shampoo all over body (from face to knees) and allow to stay on skin overnight, rinsing in the morning, once a week for 4 weeks (this may cause skin irritation)
- Topical antifungals in the imidazole family may be used instead

Question 5

What is tinea pedis?

Answer 5

Definition: fungal infection on the feet (aka athlete’s foot)

S/s:
- Red, scaling rash on soles and between the toes

Tx:
- Topical antifungal cream, powder, or spray
- Appropriate foot hygiene

Question 6

What is tinea cruris?

Answer 6

Definition: fungal infection on the groin

S/s:
- Erythema, scaling, maceration in the inguinal creases and inner thighs (penis/scrotum spared)

Tx:
- Topical antifungal preparation for 4–6 weeks

Question 7

Diaper candidiasis aka diaper rash

Answer 7

S/s:
- Fiery red lesions, scaling in the skin folds, and satellite lesions (located further out from the main rash)

Tx:

• Topical nystatin with diaper changes for several days
• See section on diaper dermatitis for additional information

Question 8

Nursing Assessments

Question 9

Nursing Management

Answer 9

Maintain appropriate hygiene and administer antifungal agents as prescribed (see Table 45.2). Additional specifics related to the individual fungal disorders are as follows:
Tinea corporis is contagious, but the child may return to day care or school once treatment has begun. Identify and treat family members or other contacts.
Counsel the child with tinea capitis and parents that hair will usually regrow in 3 to 12 months. Wash sheets and clothes in hot water to decrease the risk of the infection spreading to other family members.
Instruct the child with tinea pedis to keep the feet clean and dry. Rinse feet with water or a water/vinegar mixture and dry them well, especially between the toes. Encourage the child to wear cotton socks and shoes that allow the feet to breathe. Going barefoot at home is allowed, but flip-flops should be worn around swimming pools and in locker rooms.
Inform the child with tinea versicolor that return to normal skin pigmentation may take several months.
Counsel the child or adolescent with tinea cruris to wear cotton underwear and loose clothing. It is important to maintain good hygiene, particularly after sports practice or a sporting event.
For management of diaper candidiasis, follow the suggestions listed below in the section on diaper dermatitis.