Fungal skin diseases

There are only a few fungal infections that are capable of producing systemic disease such as candidiasis. However, a number of superficial types of fungi lives only on the uppermost layer of skin.

The most common superficial fungal infections are called tinea, or ringworm. These can attack the skin, nails and hair. In ringworm of the scalp, the light of a mercury-vapour lamp usually makes the hair fluoresce with a remarkable greenish colour.

In orthodox medicine, griseofulvin (Grisovin) and terbinafine (Lamisil) are the usual treatments, but both can have marked side-effects. There is not much in the scientific literature covering non-orthodox treatments, but there are many common-sense, home-remedies available.

In tinea pedis (athlete’s foot), warm foot baths with potassium permanganate (1 in 8000 solution, two or three times daily) often help. Once the oozing has stopped and the skin has become dry, a Melaleuca alternifolia (tea tree) ointment should be applied, and continued for two weeks after symptoms have gone. Items such as bath mats, towels and socks should be washed at a high temperature to avoid reinfection. A powder such as Mycil should be dusted liberally inside your footwear every day or, alternatively, use cottonwool to apply a potassium permanganate solution to the insides of your shoes (note: this may discolour white tennis shoes). In the case of evil-smelling (garlicky) perspiration from the affected feet, homoeopathic Tellurium 6D is indicated (Br Hom J, 1968; 58: 216-20). For the chronic dry type of athlete’s foot, Whitfield’s ointment should be applied (the original formula, according to the British Pharmacopoeia, 1934, is: boric acid 5 per cent, salicylic acid 3 per cent, white soft paraffin (Vaseline) 27.6 per cent and coconut oil 64.4 per cent).

The treatment for tinea manum (ringworm of the palm or hand) is similar, except that a herbal cream remedy containing a 50-per-cent maceration of Solanum nigrescens may also be applied daily to the affected area (J Ethnopharmacol, 1988; 22: 307-13).

For tinea unguium (fungal infection of the fingernails and toenails), use a povidone-iodine solution (Betadine surgical scrub) as a lather or as a daily foot bath for three weeks, and wait two months for the affected nails to grow out. This approach has proved successful in a number of resistant cases in my practice. It should be remembered that a complete cure of established toenail fungal infection is difficult and rare.

Tinea circinata (ringworm of the body) comes in four varieties: 1) the annular type, which produces red-ringed lesions with tiny peripheral vesicles and a clear, slightly scaly, centre; 2) the plaque type, which is less inflammatory, but can occasionally produce large plaques; 3) the follicular type, which presents as a pustular folliculitis (infection of the hair follicles) usually on the neck, shoulders and arms and may be painful (note: allowing pet white mice to run up and down the patient’s arms is a common source of this type of infection); and 4) the granulomatous type, which is characterised by lesions that look like suppurating carbuncles or boils (also called ‘cattle ringworm’, which can be transmitted from animal to patient).

Tinea cruris (jock or dhobie itch) predominantly affects the groin and perineal areas of males, and is usually spread by infected bath towels. Whitfield’s ointment should be applied daily.

Tinea versicolor or pityriasis versicolor is a gradual and symptomless disorder characterised by fawn- or café-au-lait-coloured lesions on the back, chest and other areas. It is quickly treated by a 2,5-selenium-sulphide solution (Selsun shampoo can be used) applied daily after a bath or shower and left on overnight for about 10 days.

In tinea capitis (ringworm of the scalp), Whitfield’s ointment should be applied daily to the affected parts. This is easier if the hair is very short. When the lesions are pustular, a starch poultice (cataplasma amyli) may help. This is a fine powder of polysaccharide granules from maize (Zea mays), rice (Oryza sativa), wheat (Triticum aestivum), and potato (Solanum tuberosum). A soft mush is prepared by mixing the starch with boiled water (1:10 ratio of starch to water), which is applied, still very warm, to the affected scalp.
Harald Gaier
Harald Gaier has moved to The Diagnostic Clinic (tel: 020 7009 4650).