- What Is It?
What Are the Differences Between Fungal Skin Infection and Eczema?
- Fungal skin infection is usually caused by the fungus Candida, although a few other fungal genera may also cause infection (this article concentrates Candida fungal infections). Eczema (also termed eczematous dermatitis) has many causes, but the most common is atopic dermatitis due to a lifelong inherited genetic predisposition to allergens.
- There are many types of fungal infections; for example, diaper rash, systemic candidiasis, candidal paronychia, body rash, and many others. All have slightly different symptoms depending upon where they occur in the body. Eczema, whether due to atopic dermatitis or allergic contact dermatitis has a similar appearance.
- Unfortunately, the signs and symptoms of candidal fungal infections can vary depending upon the location of the infection; some may appear as a red rash while others may be hot, itchy, and painful. Some produce softened, red skin in body skin folds, others appear to discolor the nails on fingers and toes, and still, others may produce a flat, red rash with sharp, scalloped edges. Eczema sizes symptoms usually progress from the initial intense itching stage to later red rash with bumps of different sizes that itches and may burn. Over time, cracks in the skin develop and people may develop puffy, red, and itchy eyelids.
- Eczema triggers include low humidity, skin exposure to solvents, over washing of the skin with soaps and detergents and/or lotions, rough wool clothing, food allergies, and repeated wetting and/or drying of the skin among many other triggers; in contrast, fungal skin infections are triggered by alteration of the immune system, overuse of antibiotics, occlusion of skin (especially in skin folds), and in skin areas that are often damp and subject to friction (diapers, tight-fitting clothes, especially in the summertime).
- Fungal skin infections are usually treated by two categories of antifungals; azole medications like miconazole and polyene antifungal medications like Nystatin and amphotericin B in contrast to eczema treatment that uses anti-inflammatory medications and steroid creams along with topical moisturizers and emollients to inhibit water loss from the skin and other topical treatments such as occasional use of calamine lotion.
- Fungal skin infections usually have a good prognosis and can be cured in many people; in many individuals, eczema may markedly decrease in adulthood but some of the people who have this disease often have lifelong problems with the skin and/or eye irritations, recurrent skin infections, and cold sores.
What Is a Fungal Skin Infection?
- Perlèche (also termed angular cheilitis) is a softening of the skin with deep creases around the angles of the mouth.
- Intertrigo is an irritation of the folds of the skin. Candidal infections commonly occur in warm, moist body areas, such as the underarms, in the groin, under the breasts, between the legs, and under the folds of the skin of the abdomen of people who are obese. Any breakdown, cuts, or cracks in the skin may allow this organism to penetrate.
- The candidal rash affects the diaper area (diaper rash). It is caused by a candidal infection that is allowed to penetrate the skin due to moisture.
- Candidal body rash can result from excess sweating, antibiotic use, or lack of movement leading to skin occlusion (for example, when a medication is applied to the skin and covered). It most commonly occurs in people with diabetes who are in the hospital.
- Congenital cutaneous candidiasis results from infection of an infant during passage through the birth canal. The rash appears within a few hours of delivery.
- Candidal paronychia is a chronic inflammation of the nail fold of your hand or foot. In some cases, it causes a discharge with pus and a soft, watery swelling of the area around the fingernail or toenail.
- Erosio interdigitalis blastomycetica is a candidal infection between the finger webs. Skin softening and redness occur. Moisture trapped by rings is thought to cause the condition. Risk factors include people with diabetes and those who work with water (for example, house workers, launderers, and those exposed to strong chemicals).
- Chronic mucocutaneous candidiasis is a condition that results from a genetic defect that leaves those who have it with thick, horny skin lesions and with nail abnormalities.
- Systemic candidiasis is a candidal infection throughout the body. This condition is rare. In systemic candidal disease, up to 75% of people may die. Even common mouth and vaginal yeast infections can cause critical illness, and other health complications, and can be more resistant to normal treatment. This rash can manifest with bruises that can be felt. The bruises result from a reaction response to Candida in blood vessels. Systemic yeast infections that return may be a sign of more serious diseases such as diabetes, leukemia, or AIDS.
- Ringworm is not the same as a yeast infection. Ringworm is another type of fungal infection caused by a type of fungus called a dermatophyte and can result in athlete's foot, jock itch, scalp infections, and infections of the nails and in skin folds.
What Is Eczema?
The term eczema is derived from Greek, meaning "to boil out." The name is particularly apt since to ancient medical practitioners it may have appeared that the skin was "boiling." Today the usage is rather imprecise since this term is frequently used to describe any sort of dermatitis (an inflammatory skin condition). But not all dermatitis is eczematous. All eczematous dermatitis, whether due to familial atopic dermatitis or acquired allergic contact dermatitis, has a similar appearance. Acute lesions are composed of many small fluid-filled structures called vesicles that usually reside on red, swollen skin. When these vesicles break, clear or yellowish fluid leaks out, causing characteristic weeping and oozing. When the fluid dries, it produces a thin crust that may mimic impetigo. In older lesions, these vesicles may be harder to appreciate, but an examination of the tissue under the microscope will reveal their presence.
Eczematous dermatitis has many causes. One of the most common is a condition called atopic dermatitis. Often those using the term eczema are referring to atopic dermatitis. Although atopy refers to a lifelong inherited (genetic) predisposition to inhalant allergies such as asthma and allergic rhinitis (hay fever), atopic dermatitis is not known at this time to be a pure allergic disease. Atopic patients are likely to have asthma, hay fever, and dermatitis. Atopy is a very common condition, and it affects all races and ages, including infants. About 1%-2% of adults have a skin rash, and it is even more common in children. Most affected individuals have their first episode before 5 years of age. For most, dermatitis will improve with time. For an unlucky few, atopic dermatitis is a chronic, recurrent disorder.
Other eczematous dermatoses include, but are not limited to, allergic contact dermatitis (cell-mediated allergy to a common substance such as poison oak or nickel), irritant dermatitis (from excessive contact with a harsh chemical substance), fungal infections (ringworm), scabies infestations, stasis dermatitis, very dry skin (asteatosis), pompholyx (dyshidrosis), nummular dermatitis, and seborrheic dermatitis. The differentiation among these conditions is often difficult and time-consuming. In addition, it is not uncommon for atopic dermatitis to coexist with other eczematous dermatitis.
What Are the Symptoms of a Fungal Skin Infection vs. Eczema?
Fungal Skin Infection Symptoms
Signs and symptoms of a candidal infection can vary depending on the location of the infection.
- In infants and adults, a candidal infection can appear many different ways.
- Candidal organisms naturally live on the skin, but a breakdown of the outer layers of the skin promotes the yeast's overgrowth. This typically occurs when the environment is warm and moist, such as in diaper areas and skin folds. Superficial candidal skin infections appear as a red flat rash with sharp, scalloped edges. Smaller patches of similar-appearing rash, known as "satellite lesions" or "satellite pustules," are usually nearby. These rashes may be hot, itchy, or painful.
- Intertrigo appears as softened red skin in body fold areas.
- Candidal paronychia appears as nail fold swelling.
- Mucocutaneous candidiasis appears with nail abnormalities.
- Erosio interdigitalis blastomycetica occurs in the finger webs.
- Diaper rash or other candidal infections on the skin can be treated with antifungal creams and lotions such as clotrimazole.
Ringworm is another type of fungal infection that is different from a yeast infection. Ringworm is caused by a type of fungus called a dermatophyte, and symptoms include rashes or scaly patches that may be ring-shaped. Ringworm can cause athlete's foot, jock itch, scalp infections, and infections of the nails and skin folds.
Medical professionals sometimes refer to eczema as "the itch that rashes."
- Usually, the first symptom of eczema is intense itching.
- The rash appears later and is red and has bumps of different sizes.
- The rash itches and may burn, especially on thin skin like the eyelids.
- If it is scratched, it may ooze and become crusty.
- In adults, chronic rubbing produces thickened plaques of skin.
- Having one or more round areas is referred to as nummular (coin-shaped) eczema and may be confused with fungal infections.
- Some people develop red bumps or clear fluid-filled bumps that look "bubbly" and, when scratched, add wetness to the overall appearance. This type of eczema is especially common on the sides of the finger in dyshidrotic eczema and also goes by the name pompholyx.
- Painful cracks in the skin can develop over time.
- Although the rash can be located anywhere on the body, in adults and older children, it is most often found on the neck, flexures of the arms (opposite the elbow), and flexures of the legs (opposite the knee). Infants may exhibit rash on the torso and face. It usually first appears in areas where the child can rub against sheets, since they may not have the coordination to precisely scratch yet. As the child begins to crawl, the rash involves the skin of the elbows and knees. The diaper area is often spared.
- The scalp is rarely involved.
- While the skin behind the ear may be involved, the outer ear itself is usually spared.
- Eyelids are often puffy, red, and itchy.
- The itching may be so intense that it interferes with sleep.
- While classic eczema and psoriasis are distinctly different and seldom coexist, both conditions may have severe erythrodermic (red skin) forms in which the patient has inflammation of most of the skin surface area.
- Asteatotic eczema is a term often applied to describe patients who have thin, dried, cracked-appearing skin, usually especially bad on the lower legs.
- Significant involvement of the palms and soles of the feet is not usual and may suggest a different condition such as fungal infection, scabies infestation, or allergic contact dermatitis.
What Causes a Fungal Skin Infection vs. Eczema?
Fungal Skin Infection Causes
An overgrowth of the fungus Candida is the cause of yeast infections. Candidal infections commonly occur in warm, moist body areas, such as the underarms or where skin folds over itself like breast/chest skin. Usually, the skin effectively blocks yeast, but any skin breakdown or cuts in the skin may allow this organism to penetrate and infect.
Areas typically affected by the fungus in babies include the mouth and diaper areas. Moist diapers can lead to an overgrowth of yeast.
In adults, oral yeast infections become more common with increased age. Adults can also have yeast infections around dentures, in the folds under the breast and lower abdomen, in the nail beds, and beneath other skin folds. Most of these candidal infections are superficial and clear up easily with treatment.
In women, vaginal yeast infections are the second most common reason for vaginal burning, itching, and discharge. Yeasts are found in the vagina of most women and can overgrow if the environment in the vagina changes. Antibiotic and steroid use is the most common reason for yeast overgrowth. However, pregnancy, menstruation, diabetes, and birth control pills can also contribute to developing a yeast infection. Yeast infections are more common after menopause.
Any person who has their immune system altered by disease (for example, HIV infection) or other reasons (for example, chemotherapy) is at higher risk to get a yeast infection. In some people, a yeast infection, especially if it is severe and/or recurrent, may be an indication that the person has a depressed immune system.
It is generally agreed that the tendency to atopy is inherited. For the purposes of this discussion, the terms eczema and atopic dermatitis will be synonymous. Individuals with atopic dermatitis have a variety of abnormal immunologic findings, like elevated IgE antibody (immunoglobulin E) levels and defective cell-mediated immunity, which causes difficulty in fighting off certain viral, bacterial, and fungal infections. Despite a susceptibility to certain infections, eczema is not itself contagious in any way.
Like most other noninfectious diseases, atopic skin disease can be triggered by environmental factors. One of the hallmarks of atopic dermatitis is excessive skin dryness, which seems to be due to a lack of certain skin proteins called filaggrin. Any factor that promotes dryness is likely to worsen atopic dermatitis. A very dry sleeping environment may be improved with a bedroom or house humidifier.
Common triggers of atopic dermatitis include the following:
- Harsh soaps and detergents
- Overwashing of skin
- Low humidity
- Rough wool clothing
- Occlusive rubber or plastic gloves
- Staphylococcus bacteria
- Repeated wetting and drying of the skin (as occurs with food handling or other professions requiring frequent hand washing)
- While food allergies are implicated as triggers in some patients, there is no dietary restriction or recommendation which is universally helpful.
- Eczema may be worsened by the development of additional problems such as allergic contact dermatitis, which may occur as a reaction to preservatives and active ingredients in moisturizers, and even as a reaction to the topical corticosteroids used themselves.
What Is the Treatment for a Fungal Skin Infection vs. Eczema?
Fungal Skin Infection Treatment
A wide array of treatment options are available to treat candidiasis. Options include creams, lotions, ointments, tablets or capsules, troches (lozenges), and creams. Talk to a doctor to find the option that is right for you.
Medications used to treat yeast infections generally fall into two main categories.
- Azole medications are a family of antifungal drugs that end in the suffix "-azole." They block the manufacture of ergosterol, a crucial material of the yeast cell wall. Without ergosterol, the yeast cell wall becomes leaky and the yeast dies. Because ergosterol is not a component of human membranes, azoles do not harm human cells.
- Polyene antifungal medications include nystatin and amphotericin B. Nystatin is used for thrush and superficial candidal infections. Doctors reserve amphotericin B for more serious systemic fungal infections. The antifungals work by attaching to the yeast cell wall building material, ergosterol. These medications then form artificial holes in the yeast wall that cause the yeast to leak and die.
Avoid scratching the affected area. Medical treatment includes prescription anti-inflammatory medications and steroid creams. Antibiotics may have to be prescribed to clear the affected irritation. Anti-itch creams, especially those containing hydrocortisone, may be helpful, but many experts recommend avoiding topical diphenhydramine and topical anesthetics because of concern of becoming sensitized and developing a secondary allergic contact dermatitis in reaction to these medications. Anti-itch creams containing pramoxine and menthol may be safer in this regard.
Removing exacerbating factors is a good place to start when managing eczema at home. This may be as simple as changing the laundry detergent to one that is fragrance-free or as difficult as moving to a new climate or changing jobs.
Long baths in soapy water or long hot showers may worsen eczema. On the other hand, soaking in warm, non-soapy water followed immediately by moisturizers to "seal in the moisture" is helpful. Prevent dry skin by taking short lukewarm showers or baths. Use a mild soap or body cleanser. Short contact of the skin with a shampoo is generally not a problem, but prolonged contact may worsen the rash on the neck and face. Before drying off, apply an effective emollient to wet skin. Emollients are substances that inhibit the evaporation of water. Generally, they are available in jars and have a "stiff" consistency. They do not flow and ought to leave a shine with a slightly greasy feel on the skin. Most good emollients contain petroleum jelly although certain solid vegetable shortenings do a more than a creditable job. The thicker, the better, although patient preference is usually toward thinner lotions because of ease of application and avoidance of a greasy feel. Oatmeal baths (Aveeno and others) may be soothing to itchy, fissured skin although the best outcomes will still result from applying moisturizers after rinsing off.
A patient with longstanding eczema may become sensitized to the products they are putting on the skin and develop allergic contact dermatitis that may be identical in clinical appearance. Skin allergy may develop to over-the-counter (OTC) products such as topical anesthetics, topical diphenhydramine (Benadryl), lanolin (an ingredient in Eucerin and other common moisturizers), coconut oil, and tea tree oil, or even prescription medications such as topical steroid creams.
Avoid wearing tight-fitting, rough, or scratchy clothing.
Avoid scratching the rash. If it's not possible to stop scratching, cover the area with a dressing. Wear gloves at night to minimize skin damage from scratching.
Anything that causes sweating can irritate the rash. Avoid strenuous exercise during a flare.
An anti-inflammatory topical cream may be necessary to control a flare of atopic dermatitis.
- Apply a nonprescription steroid cream (1% hydrocortisone). The cream must be applied two to four times a day without skipping days until the rash is gone.
- Diphenhydramine (Benadryl) in pill form may be taken for the itching. Caution: This medication may make people too drowsy to drive a car or operate machinery safely.
The topical form may sensitize people and cause allergic contact dermatitis.
- Clean the area with hypoallergenic soap as necessary. Most antibacterial soaps are too irritating for eczema patients. Apply an emollient over the topical steroid.
- Calamine lotion may also be soothing to the itch but will tend to dry out the skin. For this reason, it may be more useful in the management of an acute flare-up of the condition rather than a good long-term therapy.
A variety of home remedies such as apple cider vinegar and tea tree oil are frequently touted as cures for eczema, but there is little or no scientific basis for these claims. Bleach baths, on the other hand, may help. The goal of bleach baths is to suppress colonization by Staphylococcus aureus bacteria with the resulting flare that may cause. Several formulas exist, but a ½ cup of bleach for a full bathtub full of water (or ¼ cup for a half bath) is a good balance between getting the desired effect and generating irritant dermatitis. A summer substitution for bleach baths would be regular use of overchlorinated community swimming pools.
Do not expect a quick response. Atopic dermatitis is controllable but consistency in the application of treatment products is necessary.
What Is the Prognosis for Fungal Skin Infection vs. Eczema?
Fungal Skin Infection Prognosis
In most cases, yeast infections will go away completely within one to two weeks when treated appropriately.
Complications of yeast infections include the infection returning, excessive scratching may cause cracking of the skin that could lead to a secondary skin infection, and a yeast infection of the nails may cause the nails to become misshapen. In people with compromised immune systems (those who have HIV, cancer, or diabetes), widespread candidiasis may occur.
If you have recurring yeast infections or a yeast infection that does not respond to treatment, it may be an early sign of another disorder such as diabetes or HIV.
Atopic dermatitis usually spontaneously improves in most individuals after puberty. In a few unfortunate individuals, it becomes chronic, resulting in occasional flares often at times of very low humidity (such as wintertime with the heat on). It may also return much later in adulthood and may prove especially difficult to manage.
The role of psychological stress inducing flares of dermatitis is poorly understood. There is no question that when the condition flares and sleep is inhibited by itching, one's normal ability to deal with emotional problems is diminished.
Repeated scratching of the rash can cause toughening of the skin. Small patches of the skin can become thickened and like leather. This condition is called lichen simplex chronicus. The scrotum and vulva are common areas for adult patients with a history of eczema to develop a persistent itch and develop such lichenification. (It would be very unusual for the penis itself to be involved in such cases and other diagnoses should be considered if it appears to be affected.)
Eczema causes skin sores and cracks that are susceptible to infection. These infections are usually very minor, but they do require treatment with antibiotics or they may become very severe. See a health care professional if an infection is suspected.
Eczema may fade in adulthood, but people who have eczema tend to have lifelong problems with skin irritation and related problems.
- Dry, sensitive skin
- Contact dermatitis
- Skin infections and cold sores
- Eye irritations
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Skin Problems and Treatments Resources
Coenraads, Pieter-Jan. "Hand Eczema." The New England Journal of Medicine 367 (2012): 1829-1837.
Wasserbauer, N., and M. Ballow. "Atopic Dermatitis." Am J Med. 122.2 Feb. 2009: 121-125.