Cutaneous fungal infections
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Overview of Cutaneous Fungal Infections
Cutaneous fungal infections are a widespread health issue, affecting the skin, hair, and nails. These infections are caused by a variety of fungi, including dermatophytes, yeasts, and molds, and their prevalence is increasing globally due to factors like immunosuppression and changing epidemiological patterns 136789.
Common Pathogens and Epidemiology
Dermatophytes and Non-Dermatophytes
Dermatophytes, especially Trichophyton species, are the most common cause of cutaneous fungal infections worldwide, affecting both adults and children. Trichophyton rubrum is the leading pathogen overall, but Trichophyton tonsurans has recently emerged as a major cause of scalp and upper-body infections, particularly in children and increasingly in adults 6710. Other dermatophytes like Microsporum and Epidermophyton are much less common .
Non-dermatophyte fungi, such as Candida, Aspergillus, Fusarium, and Penicillium, can also cause skin infections, especially in immunocompromised individuals. These infections are often more difficult to treat and may lead to higher rates of antifungal therapy failure 5610.
Geographic and Demographic Variations
The distribution of fungal pathogens varies by region, age, and body site. In adults, infections most often affect the nails and feet, while in children, the scalp and nails are more commonly involved . Recent years have seen shifts in the types of fungi causing infections, with resistant strains and new species becoming more prevalent 67.
Clinical Features and Risk Groups
General Population
Most cutaneous fungal infections are superficial, presenting as red, itchy, or scaly patches on the skin, or as nail discoloration and thickening. These infections are usually not life-threatening but can cause significant discomfort and social stigma 16.
Immunocompromised and Pediatric Patients
Immunocompromised individuals, including those on immunosuppressive drugs, premature neonates, and patients with disrupted skin barriers, are at higher risk for deep or disseminated fungal infections. In these groups, infections can present as necrotic ulcers, papules, or more severe skin lesions, and may become life-threatening if not promptly treated 2589.
Neonates, especially those who are premature or immunocompromised, are susceptible to both common pathogens like Candida and to rare, opportunistic fungi such as Aspergillus and Zygomycetes. Prompt recognition and treatment are critical to prevent severe outcomes 25.
Diagnosis and Immune Response
Diagnosis relies on clinical examination, laboratory tests (such as cultures, PCR, and microscopy), and sometimes histopathology. Accurate identification of the causative fungus is essential for effective treatment and to prevent antifungal resistance 6710.
The immune system, particularly IL-17-producing cells, plays a key role in defending against fungal infections by promoting antimicrobial responses in the skin. However, the exact impact of these immune cells in different types of cutaneous fungal infections is still being studied .
Treatment and Management
Treatment typically involves topical or systemic antifungal agents. In severe or deep infections, especially in immunocompromised patients, aggressive surgical debridement and newer antifungal drugs like voriconazole and caspofungin may be necessary 259. The rise of antifungal resistance, particularly among Trichophyton species, highlights the need for accurate diagnosis and appropriate therapy .
Conclusion
Cutaneous fungal infections are a significant and evolving public health concern, with dermatophytes like Trichophyton species being the most common cause. The epidemiology is shifting, with new pathogens and resistant strains emerging. Immunocompromised individuals and neonates are at higher risk for severe disease. Early diagnosis and targeted treatment are essential to improve outcomes and prevent complications.
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