Everything you (n)ever wanted to know
about fungus and yeast infections...

by Dr. Mo Lerner

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In one of my previous columns I mentioned that anything that was once alive could be made into alcohol. The magic ingredient that drives this process is the yeast or fungus that is abundant in the things we eat and touch, and indeed in the very air we breathe. For the most part fungus loves to munch on dead matter, and in the case of human beings this is usually the hair, nails and superficial layers of the skin. All these areas contain dead cells.

The other two ingredients required by yeast to make alcohol are moisture and sugar, and this is true as well for most of the fungal infections in our bodies.

For large people, moist areas are often abundant for a number of reasons. Because we have a larger surface area and body mass, we tend to work harder to get around, generating heat and dissipating that heat through sweating. Also, we often have extra skin folds and these dark moist places are a favorite habitat for most fungi. Many large people have elevated levels of sugar circulating in the blood stream, partly because the pancreas cannot keep up with processing large carbohydrate loads and also simply because this organ begins to falter as we grow older.

The number and variety of fungal infections are so extensive that it would be difficult to mention them all, but I will try to discuss some of the more common ones starting with the head area and working down to the toes.

Worms that aren't
The word Tinea is from the Latin meaning grub or worm and is used in medical circles to describe most fungal infections (for reasons which will become apparent shortly). Tinea Capitis refers to fungus infection of the scalp and hair. Of interest is the fact that the most familiar culprit organism of the 1950's has gone out of vogue and a different species has taken over. I mention this because one of the most common ways doctors used to diagnose fungal infections of hair was to hold a black light (ultraviolet) near the hair, and the old species used to cause the hair to fluoresce like a neon sign. Although some species still cause fluorescence, many of the modern offenders do not. Fungus usually attacks hair by sneaking right into the roots and weakening the shaft, causing either patches of broken hair or frank bald spots. In some people the bald area may have a black dot appearance while in others with more serious infections, weepy, red lesions might appear. Treatment usually takes several months and some balding may be permanent.

Ringworm is the lay term used for centuries to describe a fungal infection that occurs on the face or other parts of the skin that looks as though a worm burrowed underneath leaving a red irregular raised circle of slightly itchy skin. Thus the term Tinea Corporis (corporis=body). This ring is simply the advancing edge of a fungus infection that has been working its way from a center lesion outward like a ripple in water. In males the infection can present as itchy red blotches in the beard.
Rest assured there is no worm involved! Some of the Ringworms can be caused by fungi that normally inhabit animals like cats, dogs, monkeys, and even cows. Whether or not humans or pets are the culprits, crowding and close contact are usually the major etiologic factors. You don't actually have to touch the source. Fungal spores travel in the air and can even stay on moist garments and objects.

Thrush and Perleche
Many of you who are parents are familiar with the term Thrush referring to white creamy patches in the mouths of some newborns. This fungal infection can be caused by exposure to the yeast that normally inhabits the vagina during childbirth. Thrush can also be associated with red irritation of the nipples during breast feeding.

In the elderly, or in those who have a habit of biting the corners of their mouths or constantly licking lips, Perleche is a related fungal infection which can be causing red, irritated, and often fissured skin at the angles of the mouth.

Coat of many colors
Tinea Versicolor is appropriately named since it presents as faint large patches of distinctly different colored, finely scaled skin, usually on the back and arms. Depending on racial background and exposure to sun, the color of the affected area can range from light pink or brown-and during tanning season-to white. People who have oily complexions, those who sweat a lot, as well as those who wear the same clothing for long periods, may harbor the offending fungus. Because the organism interferes with the body's pigment (natural sun screen), only non-infected areas will tan normally. The sharp contrast in colors are embarrassingly noticeable. Those who suffer will sympathize with Michael Jackson's dilemma (although his problem of non-matching skin tones was due to another condition) and finally realize why their backs have been slightly itchy during the winter.

Love handles and jocks
For large people possibly the most annoying and serious of the fungal infections involves the intertiginous areas of the body such as fat folds of the breasts, "love handles", and the groin. The term Intertrigo (from the Latin Terere to rub) refers to fungal infections that present themselves as shiny red or coalesced blotchy patches that appear in areas where skin chafes closely against skin. It can come on gradually or suddenly and may become quite itchy or burning in nature. If mistreated or left long enough, painful fissures can form harboring opportunistic bacteria that make the infection worse.

The vagina normally houses the Candida (from the Latin Candidus meaning "glowing white") family of fungi which live in a delicate balance with neighboring bacteria. If something upsets the environment (such as infections, medication, restrictive hot moist conditions), especially the acidity, the fungus multiplies to abnormal levels. Women may complain of a creamy or curd-like yellow discharge and itching in the vulval area. Males, especially those who are uncircumcised and/or have poor hygiene in the foreskin area, may also suffer.

Good for the sole
Tinea of the hands and soles of the feet is similar in presentation and cause. People who expose their hands to lots of moisture, such as when washing dishes or wearing gloves for long periods, may notice a thickened red or tan scaly surface appearing on their palms. The fissures, cracks and itching that eventually appear lead many to believe that they have "dry skin" or Eczema (which may very well be true). They self treat inappropriately with steroid cream or moisturizers. This might alleviate the problem in the short term because the steroid slows down the body's attempt to protect itself from the invading fungus by building up a barrier of thick scaly skin. But as with the use of these substances in other forms of Tinea, the fungus keeps coming back with a vengeance.

Tinea Pedis appears in the same fashion on the sole of the foot for those who wear tight fitting shoes for lengthy periods and/or in a humid, warm environment. But this term also refers to the most notorious of all fungal infections Athlete's Foot. Unlike the silver dry appearance on the sole, the web spaces between toes often present with red, weepy or white blistery, itchy, or burning patches.

Fungal infection of the nails can produce thick yellow "crumbling" surfaces. We tend to think of these unattractive nails as affecting only the elderly and indigent with poor hygiene. However, extensive use of nail polishes, paints, glues, and remover can be just as damaging.

It should also be noted that severe and more unusual fungal infections, such as those that invade the lungs and internal organs may be harbinger of underlying compromise of the immune system. People with cancer, AIDS, or other overwhelming infections which tax the body's defense system, may unfortunately develop an environment which allows fungus to take over.

The "azole" answer
Treatment for most of the conditions aforementioned involves two steps; medication and hygiene.

The suffix "azole" appears in the scientific names of many of the topical antifungals and for the sake of brevity I will not list them here. Topical antifungal ointments, creams, powders, and lotions interfere with fungal growth and are useful for most of the infections described above. The problem is that treatment regimens vary depending on the type and location of infection and the advice of a physician must be sought.

Fungal infections of the hair, scalp and nails may require oral medication for some time because the medication must attack from within to get at the organisms. Frequent changes of socks or use of open-toed footwear is helpful. Interestingly, scientists have recently discovered that Dandruff may be caused by a fungus and there are new shampoos and lotions (e.g. Ketoconazole) that may offer relief.

Mucosal surfaces (the lining of inside body cavities) such as the mouth and vagina require special solutions, creams, suppositories, or pills. One of the best treatments that has been used for decades involves painting the mucosa with Gentian Violet which unfortunately, as its name indicates, is a dye which can stain clothing. Use a bib or sanitary napkin to protect garments.

Many women have tried self treatment by inserting Yogurt in an effort to replenish the Lactobacillus bacteria that restore proper acidity in the vagina and which, in turn, theoretically keep the fungus at bay. Over-the-counter medications for vaginal infections abound but please be aware that other more serious problems may be masked by untrained intervention.

If you suspect animals as a source, get them looked at and treated. Boil or throw away old chronically used clothes.

Intertriginous (fat fold) infections require medication first, then once the infection is under control I suggest the following: lather with a mild antibacterial soap or dab the area with Burow's Solution (which you can get from your pharmacy) but never scrub. Rinse the area thoroughly using a shower hose if necessary. Blow dry and follow up with very finely milled corn. starch or unscented talcum powder. Some physicians prescribe solutions with Aluminum complexes (similar to ingredients in antiperspirants) to promote drying. The aim is to minimize moisture and friction in the area.

Slick commercials
Being large does not mean that you have to suffer from the discomfort or embarrassment of fungal or yeast infections. But before you run to the store and buy the miracle powder for your toes that "puts out the fire," or the vaginal suppositories that "restore your love life," remember that a person who treats him or herself has a fool for a doctor.

Be well and enjoy life. ß



Heretic Physician