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Symptoms and Signs of Fungal Skin Infection vs. Eczema

Doctor's Notes on Fungal Skin Infection vs. Eczema

The fungus Candida (commonly referred to as a yeast infection) commonly causes fungal skin infections, though some other types of fungi also may cause infection. Examples of fungal skin infections include diaper rash, systemic candidiasis, candidal paronychia, and body rash. Eczema (also called eczematous dermatitis) is a common skin condition that causes skin irritation and inflammation.

Symptoms and signs of candidal fungal infections and eczema that are similar include skin redness, itching (may be intense), and red rash. Signs and symptoms of fungal skin infections vary depending on the location of the infection and may also include softened red skin in body fold areas, hot and painful skin, and discoloration of the fingernails and toenails. Symptoms and signs of eczema also include bumps that itch and burn, painful cracks in the skin, puffy/red/itching eyelids, and oozing or crusty sores.

Medical Author:
Medically Reviewed on 6/3/2019

Fungal Skin Infection vs. Eczema Symptoms

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 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.
    • If the rash worsens at any time or if the lesions do not clear up in one to two weeks, call a doctor.
    • Fever, chills, nausea, vomiting, or the rash spreading to other parts of the body may be a sign of a more serious illness.

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 in skin folds.

Eczema Symptoms

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 in 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 legs (opposite the knee). Infants may exhibit the 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.

Fungal Skin Infection vs. Eczema Causes

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.

Eczema Causes

It is generally agreed that the tendency to atopy is inherited. For the purposes of this discussion, the term 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 a lack of certain skin proteins called filaggrins. 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
  • Solvents
  • Low humidity
  • Lotions
  • Rough wool clothing
  • Sweating
  • Occlusive rubber or plastic gloves
  • Rubbing
  • 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.

Fungus Among Us What to Know About Fungal Infections in Pictures Slideshow

Fungus Among Us What to Know About Fungal Infections in Pictures Slideshow

Fungal skin infections can be itchy and annoying, but they're rarely serious. Common infections such as athlete's foot, jock itch, and ringworm are caused by fungus and are easy to get and to pass around. In healthy people, they usually don't spread beyond the skin's surface, so they're easy to treat. If you spend a lot of time at the gym, take steps to protect yourself against fungal infections.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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