For Susan, the infection began as a small rash on the calf (back portion of the lower leg). The rash did not itch but when she wore trousers, the heat caused discomfort to the spot.
“Scratching would cause sweet relief and once I began it was hard to stop,” she says.
Within two weeks she had developed blisters and they were emitting a clear fluid.
The pharmacist told her she was suffering from an allergy and prescribed a host of tubes.
“I got brown patches on the soles of my feet and they were itchy too. Only the itch was constant this time and my nails became ineffective in reaching that itch, I began scratching at them with blunt metals,” she explains.
Eventually, a dermatologist diagnosed the patches as a fungal infection that took two types of drugs to heal.
Different species of fungi live on all the surfaces of the body. Some of these fungi are useful, and some produce no harm or benefit.
However, on occasion, they can turn against the host body. A host of environmental and physiological conditions contribute to the development of fungal infections. Most of these conditions are related to hygiene and immune levels of the host body.
Fungal infections are classified according to location. Infections of the soles of the feet are tinea pedis, on the hands are called tinea manuum. When the infection covers the nails, it is called tinea unguium.
Source of fungal infections
Dermatologist Edward Ogwang of The Skin Specialist Clinic, says most fungal infections are caused by dermatophytes, which are fungi that feed on dead skin. The outer layer of the skin is made up of dead cells which dermatophytes cannot penetrate to enter the blood stream. This dead skin includes the soles of the feet.
Fungal infections thrive in warm and humid environs and are spread through direct contact with infected people, animals and the environment. Indirectly, fungal infections are spread through contact with infected skin or hair, clothing, combs, bed linen or surfaces in the bathroom.
“People should avoid walking barefoot in public areas because fungi can stay on the ground for up to six months,” says Ogwang.
It is also advisable to wash secondhand clothing bought from the market because the fungi have the ability to stay in the clothing for months.
Dr Francis Asiimwe, a dermatologist at Unity Skin Clinic has found fungal infections, in his experience, to be an occupational hazard.
“People working in medical, veterinary, and hospitality professions which involve a high level of contact are vulnerable, and if not treated, these infections can remain on the skin for years,” he says.
Unkempt pets can pass on fungi to humans when they bite or scratch them. Coming into contact with an infected animal’s waste, saliva and fur or skin can also lead to a transmission of the infection.
Long-term dependence on antibiotics eventually alters the balance of micro-organisms in the body, leading to overgrowth of fungi. People with weak immune systems, HIV and patients on chemotherapy, are at high risk. Children, pregnant women and elderly people are also a risk group.
“In some families one person may get a tinea attack which will not spread to other family members,” says Asiimwe. “Ideally, proper hygiene should be enough to fight off these infections, but genetics also come into play. Some people are born with generally weak immunity and find it hard to fight off opportunistic infections.”
Scaly patches of skin are signs of fungal infection. They may occur in isolation or spread out across the skin. Usually, they do not itch unless they are inflamed, causing blisters. When these blisters are scratched they ooze pus from exposure, and are vulnerable to bacterial infections.
When the infection spreads to the nails, it causes them to thicken, lose texture and turn either black. In some cases, the nail will fall out.
Diagnosis and treatment
Dr Ogwang says it is dangerous to seek treatment across the counter because some lesions may look like fungi when they are not. Anti-fungal drugs are not only costly, but are strong and if administered wrongly can cause damage to the liver.
For diagnosis, a dermatologist will scrap skin off the affected area for a microscopic examination. Topical therapy (tubes) is used for most infections, but in advanced cases, this is administered with oral therapy (tablets).
“One should visit the doctor when they notice abnormal skin,” says Dr Asiimwe, adding, “many fungal infections are mismanaged because of poor health-seeking behaviour among the population. They come to us when they have failed with local treatments and by this time, the cases are advanced.”
If untreated, the blisters can peel making the infected area vulnerable to bacterial infections. These bacteria may end up in the blood stream causing septicemia, which is fatal.
Fungi, in its advanced form, also have psychological effects on the infected person. Oddly shaped and discoloured nails and disfiguring spots can cause them to be ashamed of socialising with their peers.