Fungal Infections (Onychomycosis, Tinea Pedis, Tinea Cruris, Tinea Capitis, Tinea Manuum, Tinea Corporis, different Candida Infections, and Pityriasis Versicolor) and Mycological Laboratory Analyses

  • Avner Shemer
  • Meir Babaev


This chapter deals with superficial fungal infections from the scope of gender dermatology. Onychomycosis occurs in both sexes, but it is more common in males. While generally more effective than topical treatment for onychomycosis, systemic treatment should be avoided in pregnancy and its use is limited due to drug-drug interactions and potential side effects. Tinea pedis is three times more frequent in males due to habitual and occupational differences. Tinea cruris is almost exclusively found in males because of the humidity created by the scrotum. Tinea capitis is seen in children without gender differences and warrants systemic treatment. Tinea manuum is a rare fungal infection of the palms that tends to be unilateral and warrants systemic treatment. Dermatophytosis of the body has different clinical types that are described in the chapter. The chapter also discusses different clinical types of cutaneous and genital candidiasis which is the leading cause of fungal infections worldwide. The chapter concludes with pityriasis versicolor and mycological laboratory analysis.


Fungal infections Mycology Onychomycosis Tinea pedis Tinea cruris Tinea capitis Tinea manuum Tinea corporis Candida Pityriasis versicolor Mycological culture 


  1. 1.
    Gupta AK, Jain HC, Lynde CW, Macdonald P, Cooper EA, Summerbell RC. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter canadian survey of 15,000 patients. J Am Acad Dermatol. 2000;43(2 Pt 1):244–8.CrossRefGoogle Scholar
  2. 2.
    Ellabib MS, Agaj M, Khalifa Z, Kavanagh K. Yeasts of the genus Candida are the dominant cause of onychomycosis in Libyan women but not men: results of a 2-year surveillance study. Br J Dermatol. 2002;146(6):1038–41.CrossRefGoogle Scholar
  3. 3.
    Elewski BE. Onychomycosis: pathogenesis, diagnosis, and management. Clin Microbiol Rev. 1998;11(3):415–29.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Elewski BE, Charif MA. Prevalence of onychomycosis in patients attending a dermatology clinic in northeastern Ohio for other conditions. Arch Dermatol. 1997;133(9):1172–3.CrossRefGoogle Scholar
  5. 5.
    Sigurgeirsson B, Baran R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol. 2014;28(11):1480–91.CrossRefGoogle Scholar
  6. 6.
    Rossaneis MA, Haddad Mdo C, Mathias TA, Marcon SS. Differences in foot self-care and lifestyle between men and women with diabetes mellitus. Rev Lat Am Enfermagem. 2016;24:e2761.CrossRefGoogle Scholar
  7. 7.
    Avner S, Nir N, Henri T. Fifth toenail clinical response to systemic antifungal therapy is not a marker of successful therapy for other toenails with onychomycosis. J Eur Acad Dermatol Venereol. 2006;20(10):1194–6.CrossRefGoogle Scholar
  8. 8.
    Gupta AK, Ryder JE, Johnson AM. Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis. Br J Dermatol. 2004;150(3):537–44.CrossRefGoogle Scholar
  9. 9.
    Segal R, Shemer A, Hochberg M, Keness Y, Shvarzman R, Mandelblat M, Frenkel M, Segal E. Onychomycosis in Israel: epidemiological aspects. Mycoses. 2015;58(3):133–9.CrossRefGoogle Scholar
  10. 10.
    Gupta AK, De Doncker P, Haneke E. Itraconazole pulse therapy for the treatment of Candida onychomycosis. J Eur Acad Dermatol Venereol. 2001;15(2):112–5.CrossRefGoogle Scholar
  11. 11.
    Gupta AK, Gregurek-Novak T, Konnikov N, Lynde CW, Hofstader S, Summerbell RC. Itraconazole and terbinafine treatment of some nondermatophyte molds causing onychomycosis of the toes and a review of the literature. J Cutan Med Surg. 2001;5(3):206–10.CrossRefGoogle Scholar
  12. 12.
    Scher RK, Breneman D, Rich P, Savin RC, Feingold DS, Konnikov N, Shupack JL, Pinnell S, Levine N, Lowe NJ, Aly R, Odom RB, Greer DL, Morman MR, Bucko AD, Tschen EH, Elewski BE, Smith EB. Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of distal subungual onychomycosis of the toenail. J Am Acad Dermatol. 1998;38(6 Pt 2):S77–86.CrossRefGoogle Scholar
  13. 13.
    Food, Drug Administration HHS. Content and format of labeling for human prescription drug and biological products; requirements for pregnancy and lactation labeling. Final Rule Fed Regist. 2014;79(233):72063–103.Google Scholar
  14. 14.
    Del Rosso JQ. Application of nail polish during topical management of onychomycosis: are data available to guide the clinician about what to tell their patients? J Clin Aesthet Dermatol. 2016;9(8):29–36.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Rosen T. Evaluation of gender as a clinically relevant outcome variable in the treatment of onychomycosis with efinaconazole topical solution 10. Cutis. 2015;96(3):197–201.Google Scholar
  16. 16.
    Ilkit M, Tanir F, Hazar S, Gumusay T, Akbab M. Epidemiology of tinea pedis and toenail tinea unguium in worshippers in the mosques in Adana. Turkey J Dermatol. 2005;32(9):698–704.CrossRefGoogle Scholar
  17. 17.
    Cheng S, Chong L. A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong. Chin Med J. 2002;115(6):860–5.Google Scholar
  18. 18.
    Kamihama T, Kimura T, Hosokawa JI, Ueji M, Takase T, Tagami K. Tinea pedis outbreak in swimming pools in Japan. Public Health. 1997;111(4):249–53.CrossRefGoogle Scholar
  19. 19.
    Aste N, Pau M, Aste N, Biggio P. Tinea pedis observed in Cagliari, Italy, between 1996 and 2000. Mycoses. 2003;46(1-2):38–41.CrossRefGoogle Scholar
  20. 20.
    Vella Zahra L, Gatt P, Boffa MJ, Borg E, Mifsud E, Scerri L, Vella Briffa D, Pace JL. Characteristics of superficial mycoses in Malta. Int J Dermatol. 2003;42(4):265–71.CrossRefGoogle Scholar
  21. 21.
    al-Sogair SM, Moawad MK, al-Humaidan YM. Fungal infection as a cause of skin disease in the eastern province of Saudi Arabia: tinea corporis and tinea cruris. Mycoses. 1991;34(9-10):423–7.CrossRefGoogle Scholar
  22. 22.
    Imwidthaya S, Thianprasit M. A study of dermatophytoses in Bangkok (Thailand). Mycopathologia. 1988;102(1):13–6.CrossRefGoogle Scholar
  23. 23.
    Odom R. Pathophysiology of dermatophyte infections. J Am Acad Dermatol. 1993;28(5 Pt 1):S2–7.CrossRefGoogle Scholar
  24. 24.
    Blank F, Mann SJ. Trichophyton rubrum infections according to age, anatomical distribution and sex. Br J Dermatol. 1975;92(2):171–4.CrossRefGoogle Scholar
  25. 25.
    Blank F, Mann SJ, Reale RA. Distribution of dermatophytosis according to age, ethnic group and sex. Sabouraudia. 1974;12(3):352–61.CrossRefGoogle Scholar
  26. 26.
    Otero L, Palacio V, Vazquez F. Tinea cruris in female prostitutes. Mycopathologia. 2002;153(1):29–31.CrossRefGoogle Scholar
  27. 27.
    Shemer A, Plotnik IB, Davidovici B, Grunwald MH, Magun R, Amichai B. Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study. J Dtsch Dermatol Ges. 2013;11(8):737–41. 737-42Google Scholar
  28. 28.
    Aste N, Pau M, Biggio P. Tinea capitis in adults. Mycoses. 1996;39(7-8):299–301.CrossRefGoogle Scholar
  29. 29.
    Lopez-Gomez S, Del Palacio A, Van Cutsem J, Soledad Cuetara M, Iglesias L, Rodriguez-Noriega A. Itraconazole versus griseofulvin in the treatment of tinea capitis: a double-blind randomized study in children. Int J Dermatol. 1994;33(10):743–7.CrossRefGoogle Scholar
  30. 30.
    Gonzalez U, Seaton T, Bergus G, Jacobson J, Martinez-Monzon C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007;4:CD004685.Google Scholar
  31. 31.
    Chen X, Jiang X, Yang M, Bennett C, Gonzalez U, Lin X, Hua X, Xue S, Zhang M. Systemic antifungal therapy for tinea capitis in children: an abridged Cochrane review. J Am Acad Dermatol. 2017;76(2):368–74.CrossRefGoogle Scholar
  32. 32.
    Proudfoot LE, Higgins EM, Morris-Jones R. A retrospective study of the management of pediatric kerion in Trichophyton tonsurans infection. Pediatr Dermatol. 2011;28(6):655–7.CrossRefGoogle Scholar
  33. 33.
    Daniel CR 3rd, Gupta AK, Daniel MP, Daniel CM. Two feet-one hand syndrome: a retrospective multicenter survey. Int J Dermatol. 1997;36(9):658–60.CrossRefGoogle Scholar
  34. 34.
    Ohno S, Tanabe H, Kawasaki M, Horiguchi Y. Tinea corporis with acute inflammation caused by Trichophyton tonsurans. J Dermatol. 2008;35(9):590–3.CrossRefGoogle Scholar
  35. 35.
    Elgart ML. Tinea incognito: an update on Majocchi granuloma. Dermatol Clin. 1996;14(1):51–5.CrossRefGoogle Scholar
  36. 36.
    Sneppen I, Thorup J. Foreskin morbidity in uncircumcised males. Pediatrics. 2016;137(5):e20154340. Scholar
  37. 37.
    Terragni L, Lasagni A, Oriani A, Gelmetti C. Pityriasis versicolor in the pediatric age. Pediatr Dermatol. 1991;8(1):9–12.CrossRefGoogle Scholar
  38. 38.
    Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor. Int J Dermatol. 1998;37(9):648–55.CrossRefGoogle Scholar
  39. 39.
    Wyre HW Jr, Johnson WT. Neonatal pityriasis versicolor. Arch Dermatol. 1981;117(11):752–3.CrossRefGoogle Scholar
  40. 40.
    Jubert E, Martin-Santiago A, Bernardino M, Bauza A. Neonatal pityriasis versicolor. Pediatr Infect Dis J. 2015;34(3):329–30.CrossRefGoogle Scholar
  41. 41.
    Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL Jr. Skin diseases associated with Malassezia species. J Am Acad Dermatol. 2004;51(5):785–98.CrossRefGoogle Scholar
  42. 42.
    Gaitanis G, Magiatis P, Hantschke M, Bassukas ID, Velegraki A. The Malassezia genus in skin and systemic diseases. Clin Microbiol Rev. 2012;25(1):106–41.CrossRefGoogle Scholar
  43. 43.
    Mendez-Tovar LJ. Pathogenesis of dermatophytosis and tinea versicolor. Clin Dermatol. 2010;28(2):185–9.CrossRefGoogle Scholar
  44. 44.
    He SM, Du WD, Yang S, Zhou SM, Li W, Wang J, Xiao FL, Xu SX, Zhang XJ. The genetic epidemiology of tinea versicolor in China. Mycoses. 2008;51(1):55–62.Google Scholar
  45. 45.
    Shi TW, Ren XK, Yu HX, Tang YB. Roles of adapalene in the treatment of pityriasis versicolor. Dermatology. 2012;224(2):184–8.CrossRefGoogle Scholar
  46. 46.
    Shi TW, Zhang JA, Tang YB, Yu HX, Li ZG, Yu JB. A randomized controlled trial of combination treatment with ketoconazole 2% cream and adapalene 0.1% gel in pityriasis versicolor. J Dermatolog Treat. 2015;26(2):143–6.CrossRefGoogle Scholar
  47. 47.
    Rivard SC. Pityriasis versicolor: avoiding pitfalls in disease diagnosis and therapy. Mil Med. 2013;178(8):904–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Avner Shemer
    • 1
    • 2
  • Meir Babaev
    • 3
  1. 1.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  2. 2.Department of DermatologySheba Medical Center, Tel-HashomerRamat GanIsrael
  3. 3.Division of Medicine, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael

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