Fungal infections: keeping them from spreading and returning

Fungus grows where skin is warm, damp and closed. A cream treats the patch you can see; keeping it from spreading and returning is a laundry, clothing and blood-sugar problem, not only a skin one.

What it usually looks like

• A ring with a raised, scaly, itchy edge and clearer skin in the middle, growing slowly outward. That is the classic ringworm picture.
• Redness and rawness in the folds: groin, armpits, under the breasts, between the toes, and the creases of the belly.
• Itch that is worse with sweat, at night, and under warm clothing, and better when the area is dry and cool.
• Feet with peeling between the toes and a sour smell; nails that turn thick, dull, crumbly or lifted.
• Brown or pale patches on the trunk and neck that barely itch and do not clear with soap.

Why it keeps coming back

This is the real problem, and it is almost never the cream failing.

• The cream is stopped the day the itch stops. The fungus is still in the skin around the visible edge.
• A steroid mix from the chemist counter calms the redness beautifully and feeds the infection quietly, so it spreads wider and returns harder.
• The same towel, the same underwear, the same shoes, and the bedsheets nobody changed that week.
• Sweating into tight synthetic trousers, gym kit left on, and wet hair tied under a cap.
• One person's ringworm shared through a towel, a bath loofah or a razor.
• Blood sugar that runs high. Recurring fungal infection is often the first thing that shows it.

What to do about the patch

• A plain antifungal cream, without a steroid in it, from the pharmacist. Read the label for how many weeks it asks for and finish that.
• Apply it a good two centimetres beyond the visible edge, because the growing part is outside the ring you can see.
• Keep it going for one to two weeks after the skin looks normal. This is the instruction most people skip.
• Wash hands before and after. The fingers carry it to the next fold.
• For the feet, treat the toes and the soles together, and dry between the toes after washing. Damp toes re-infect the groin through the same underwear.
• If nails or scalp are involved, a cream is not enough and a physician has to be seen; these need treatment taken by mouth.

The household half of the cure

• Cotton underwear, loose trousers, and a change the moment you are sweaty, not once a day by habit.
• Underwear and towels washed hot, dried in direct sun, and the seams of the underwear ironed. The fungus survives a cool wash.
• A separate towel for the affected area, and never the face towel on the groin.
• Shoes rotated so each pair dries for a day, and socks changed daily.
• No sharing of towels, loofahs, razors, shoes or a gym mat without wiping it.
• Keep the folds dry after a bath. A clean cotton cloth pressed into the crease does more than any powder.
• An antifungal dusting powder can help in the daytime, but it is not a substitute for the cream and should not run for months.

What not to do

• No three-in-one creams with a steroid in them, and no tube someone else used successfully for something else.
• No garlic, tea tree oil, vinegar or lemon rubbed on broken or raw skin. They burn, and a burn in a fold becomes a second infection.
• No scrubbing the patch to remove the scales, and no hot water to kill the itch. Both make it angrier.
• Do not shave or wax over an active patch; the blade carries it along the whole area.
• Do not scratch with the nails. Trim them short, and cool compress instead.
• No daily full-body antifungal bath for months on end, and no oral medicine bought without a prescription.

What Aksa looks at

Recurring ringworm and fold infections are among the complaints our skin clinic sees most, and the visit is not only about the patch.

• Blood sugar and the pattern of thirst, urination and weight that goes with it.
• Every cream already used on it, which is how long the area has been under a steroid.
• Sweating, weight, the clothes worn to work, and who else at home has started itching.
• Whether the nails or scalp are involved, because that changes the treatment entirely.

When to see a doctor

• The patch is on the face, the genitals, the scalp, or the nails.
• It is spreading despite two to three weeks of a correct cream, or many areas are involved.
• There is pus, crusting, swelling, warmth or fever along with it, which means bacteria have joined in.
• You have diabetes, are on steroids or other immunity-lowering treatment, are pregnant, or the patient is a child.
• The itch is stopping sleep, or the skin is broken from scratching.
• It keeps returning within weeks of clearing, every time, which is a signal to look inside and not only at the skin.

In a free video consultation an Aksa physician looks at the patches, the creams already used and the sweat and sugar picture behind them, and sets out a routine that stops the round trip rather than the next attack.

Every individual is different. This page is general education, not a prescription for you, and it cannot replace an examination.