Lifestyle Choices

Fungi

Several fungi can infect human skin, nails and hair. Those fungi which normally live in the soil or on animals tend to produce inflammation as well as scaling but those which are specifically human fungi give rise to little reaction on the skin. The term ringworm is used because many fungal infections produce a circular rash.

Ringworm

Ringworm on the foot is also called athlete’s foot and it is the most widespread form of fungal infection. It is easily spread from one person to another and swimming baths and changing rooms are likely sources of infection. The usual changes are redness, scaling and maceration in the space between fourth and fifth toes, and it may be accompanied by small blisters. It may remain like this for years causing no discomfort, however, it may itch and spread to the other web spaces or other body sites.

Ringworm of the groin is particularly common in sportsmen and may be spread from one person to another by the sharing of a towel. Some fungi cause only slight redness and scaling whereas others may be associated with certain occupations in adults e.g. mining.

Ringworm of the nails

Ringworm of the nails is often seen with infection of the surrounding skin, but the most important causes of fungi invading the nail are trauma and poor circulation. The infection may enter at the free edge of the nail or to one side. Spread is progressively across the nail plate until most of it is involved. It may become thick, crumbly and discolored. Often only one nail is involved and it is usually a toenail.

Ringworm of the scalp and hair

A fungus called microsporum may cause bald, scaling patches on the scalp in children. It shows a green fluorescent color under ultraviolet light. Spread to other children at school is frequent so the child should be kept at home until treatment is well under way. Other fungi may cause inflamed, soggy areas with pus and hair loss.

Yeasts

The most important yeast is candida and infections caused by this microbe are commonly called ‘thrush’. The yeast is constantly present but does not grow profusely unless there is a suitable warm and moist area of skin available. It favors the groin folds and armpits in overweight people, the skin under heavy breasts and the nappy area in babies. The result of candida overgrowth is red, glazed skin or sometimes a little scaling with eroded areas. These changes are more likely to appear in diabetics and those with a lowered resistance for other reasons.

What to do

Good hygiene helps to prevent thrush but it may be necessary to use anti-yeast creams such as Nystatin, Canesten or Daktarin. They are quickly effective but the yeast may return if the rolls of fat remain.

Infestations

Scabies

Scabies is an infection with a particular type of mite - Sarcoptes scahie - which is less than 1/20 inch long. The mite is passed from person to person by prolonged close contact . Holding hands for a time, sitting with an infested infant on your knee or sleeping with an infested person are the usual methods of transmission. The mites cannot survive for long in clothes or bedsheets.

Female mites burrow under the very top layer of skin (stratum corneum) where they lay their eggs. For four to six weeks there is no itching. But when it begins it soon dominates the picture and is particularly trying at night. Although the skin itches almost everywhere, ‘With the exception of the head and neck, the mites in their burrows are found in only a few areas. These areas include the sides of the fingers and hands, the wrists, genitals, nipples and feet. A burrow is easily missed, being a gray-white line of no more than half an inch in length. The mite can be seen as a small dark dot at the end of the burrow.

Lice

Lice are insects and three types are partial to humans. They live in hairy areas and have legs which are especially adapted for grasping hairs. They feed on blood and inject their saliva. The puncture marks in the skin are the site of itching and sometimes bacterial infection is set off in this way. Each female louse lives about one month and lays up to ten eggs a day. These take a week to hatch and stick firmly, as small oval capsules, onto a hair shaft or strand of clothing material.

Head lice (Pediculosus humanus) are mostly found in children. Their eggs, or nits, are easily seen in scalp hair. There is often considerable itching and scratching and if a lot of infection develops the child may feel unwell.

Body lice are a subgroup of Pediculosus humanus. They are less common now and are seldom seen outside the unhygienic and socially deprived. Widespread itching and scratching may be followed by a pigmentation of the skin. The eggs are found mainly on the seams of clothing.

Pubic lice (Phthirus pubis) are common and tend to affect young adults. They are spread by sexual contact and by shared towels and clothes. Most of the eggs are found on the pubic hairs.

What to do

In the case of head lice it should be remembered that spread from one person to another is by sharing hats, combs, brushes or close head to head contact. Body lice are transmitted by clothing or bedding. They need to be killed in the clothing by boiling, ironing the seams or dry cleaning. Apart from these measures it is necessary to apply an insecticide to the skin or hair. Gamma benzene hexachloride or malathion are effective for most lice infestations and can be bought without a prescription. It may be wise to repeat treatment weekly for a week or two in case further eggs hatch out. Other family members and classmates should be checked carefully for lice.

Papular urticaria

This is a skin problem affecting mainly children between the ages of two and seven but older children are occasionally seen with a rash. Red, firm pimples and blisters of various sizes lasting two to ten days are seen on the lower legs and sometimes the arms. They are in groups of ten. A sibling may have a similar problem. They result from insect bites to which the individuals have developed a marked sensitivity. The insects could be fleas, bed bugs, mosquitoes or house dust mites but may not be identified if they live on carpets and furnishings. Parents are often offended at the suggestion of insects in their house but there are few houses without some insects: the only change has been the onset of allergic reaction to the bites. To understand this it should be remembered that some people react strongly to mosquito bites while others do not. Fortunately, the strong skin reaction which produces papular urticaria settles in the end, but it may take months to do so.

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